LIBRARY OF CONGRESS. 



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UNITED STATES OF AMERICA. 



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PURPURA 



. 



Purpura. 



BY 



George William Winterburn, Ph. D., M.D. 

Editor of the American Homceopathist. 

President of the American Obstetrical Society: Formerly Lecturer 

on Clinical Medicine, and Physician-in-Chief to the Manhattan 

Hospital: Fellow of the American Akademe; Member 

of the Academy of Anthropology, of the New 

York Academy of Sciences, of the American 

Institute of Hoimeopath3\ and of 

other Learned Societies, 

etc., etc. 




NEW YORK : 
A. L. CHATTERTON & CO. 

1886. 









M 



Copyright, 1886, by Geo. W. Winterburn. 






TO 

PROF. SAMUEL LILIENTHAL, M. D. 

WHO, BY HIS PROFESSIONAL WORTH AND INDUSTRY, 
HAS DONE SO MUCH TO ESTABLISH SCIENTIFIC 
THERAPEUTICS, THIS VOLUME IS GRATE- 
FULLY DEDICATED. 



INDEX. 



Aconite in purpura, 145 
Allen, Richard C, 
case, 130. 
Arnica, 157. 

Arnold, William, case, 87. 
Arsenicum. 104. 
Artificial production of pur- 
pura, the, 20. 

Begbie, J. Wharton, ob- 
servation in regard to 

terebinthina, 149. 
Belcher, Geo. E.,case, 140. 
Berberis, 215. 
Boyce, C. W., case, 84. 
Brown, Crichton, cases, 

173. 
Brown, Dyce, observation 

on chloral, 178. 
Bryonia, 169. 
Buchmann, of Alvensleben, 

case, 186. 
Bumstead, Freeman J., case 

183. 
Burnett, J. Compton, cases, 

91. 

Cardiac debility as a cause 
of purpura, 18. 
Cheyne's theory, 22. 



China, 119. 

Chloral, 172. 

Clark, John H., cases, 158. 

Clary, W. J., cases, 74. 

Comstock, T. G., case, 151. 

Crotalus, 69. 

Cuprum, 190. 

Decker, W. M.. case, 193. 
Detwiler, H., case. 154. 
Diagnosis, 60. 
Doane, W*C, case, 144. 



Erigeron, 156. 
Etiolosrv. 1 



Etiology, 14. 

Ferrum phosphoricum, 216. 
Fiske, W. M. L., case, 
111. 
Fox, Tilbury, observation, 

181. 
Frerich's theory, 22. 

Gage, J. L., cases, 118, 137, 
1(55. 

Hale, E. M., cases, 156, 
165. 
Hale, Dr. , of Hastings, Eng- 
land, case, 166. 



r :x d e x 



Hayward, J. W., cases, 73. 

Hetnigke, C, case, 112. 

Hering, Constantine, case, 
102. 

Hoyne, TempleS., cases, 90. 

Hughes, Richard, observa- 
tion on mercurius, 185. 

— on the febrile form, 145. 

Hydrocyanic acid, 209. 



J 



\odum, 180. 

ahr, G. H. G., case, 105. 
.Jones, S. D., case, 111. 



Kali hydriodicum, 181. 
Kimball, L. Hough- 
ton, case, 147. 
Kippax, J. R., cases, 118, 

157, 214, 218. 
Kissel, Dr., case, 192. 

Lachesis, 93. 
Ledum, 213. 
Ludlam, R., case, 209. 

Lycopodiuvi , 216. 



M 



organ, John C, case, 
144, 164, 217. 



Ockford, G. M., case, 109. 
Okie, Dr., case, 142. 

Pathology, 22. 
Pease, G. M., cases, 97. 



Phosphorus, 77. 
Post-mortem appearances, 

24. 
Price, Elias C, cases, 91, 

171. 
Prognosis, 62. 
Purpura simplex, 52. 

— hemorrhagica, 54. 

— rheumatica, 57. 



R 



epertory, 219. 
Rhus, 128. 



Sanguinaria, 193. 
Secale, 112. 
Seward, John L. , cases, 99, 

170. 
Small, A. E., cases. 66, 109. 
Sidphuric acid, 163. 
Symptoms, 25. 



T 



erebinthina, 149. 
Treatment, 63. 



Varieties, 51. 



Venesection in pur- 
pura, 145. 

WESSELHOEFT, CONRAD, 
case, 97. 
Williams, of Liverpool, 

case, 167. 
Winterburn, Geo. W., cas- 
es, 115, 121, 131, 204. 













PAGE 


I. Purpura. 


- 


11 


Etiology, 


- 


14 


Pathology, 


. 


22 


Symptoms, 


" , ■ 


25 


Varieties, 


. 


51 


Diagnosis, 


- 


60 


Prognosis, 


. - 


62 


Treatment, 


- 


63 


II. The Remedies and Their Indications. 




Crotalus, 


. 


69 


Phosphorus, 


- 


77 


Lachesis, 


..... 


93 


Arsenicum, 


. 


104 


Secale, 


.... 


- 112 


China, 


. 


119 


Rhus, 


: . 


- 128 


Hamamelis, 


. 


139 


Terebinthina, 


. 


- 149 


Erigeron, 


. 


156 


Arnica, 


. 


- 157 


Sulphuric A.cid, 


. 


- 163 



8 CONTENTS. ' 

PAGE 

Bryonia, - - - - - 169 

Chloral, - - - - 172 

Iodum, - - - - 180 

Kali hydriodicum, - - - - 181 

Mercurius, - - - - - - 185 

Cuprum aceticum, - 190 

Sanguinaria, - - - - - 193 

Hydrocyanic acid, - 209 

Ledum, - - 213 

Berberis vulgaris, - 215 
Lycopodium, _____ 216 

Ferrum phosphoricum, - - 216 

III. Therapeutic Digest, - - - - 219 

IV. Index, - 5-6 



PREFACE 



At the annual meeting of our State Society 
this year, the topic of the Materia Medica of 
Haemorrhage was selected as one of the special 
subjects for study, and to me was assigned the 
duty of writing up so much of that topic as 
pertained to Purpura hemorrhagica, a disease 
in which my experience was limited, and of 
which I knew very little. Conversation with 
professional associates developed the interesting 
fact that I was not alone in mental nebulosity 
on this subject, and I then set myself system- 
atically to work to study it up. The result is 
bound within these covers. I have endeavored 
to garner the experience and wisdom of the 
profession, and to present it in such a conven- 
ient shape that he who runs may read. There 
have been a number of interesting cases con- 
tributed at various times to periodical literature, 
and of these I have here presented all that 
have seemed to me to possess practical value, 
as far as I have been able to secure them ; and 



10 PRE F ACE. 

I have waded through many hundreds of 
volumes for the results obtained. In addition 
to this, I have secured some thirty odd hereto- 
fore unpublished cases, many of them of great 
value as studies in therapeutics. In a word, 
while I have but four cases to report of my 
own, and indeed one of these has been added 
just as the manuscript is completed, I have 
been able, through the generosity of my con- 
freres, to place in orderly array so much that 
possesses intrinsic worth, that the subject is* 
lifted from therapeutic obscurity to compara- 
tive practical certainty. 

It was utterly outside of my intention to do 
more than present a creditable and useful 
paper to the society which honored me in its 
selection ; but the material soon outgrew the 
limits of such a report, and encouraged by the 
suggestions of those who desired to possess the 
therapeutics of this interesting disorder, in a 
convenient form, it is sent forth in its present 

shape. 

G. W. W., 

No. 29 West Twenty-Sixth St., 

New York, Nov. 2, 1885. 



PURPURA. 



The peculiar discoloration of tlie skin, from 
which this disorder takes its name, is caused 
by haemorrhage into the cutaneous substance. 
Extravasation of blood into the tissues, more 
especially into the skin and mucous membrane, 
is a symptom common to many affections. 
Thus in the course of malignant diseases, such 
as diphtheria, smallpox, or scarlatina, haemor- 
rhage into the tissues is by no means uncom- 
mon. A like condition is caused by certain 
corrosive drugs, such as phosphorus. A more 
persistent and characteristic haemorrhage is a 
factor in that sequence of symptoms which we 
denominate as scurvy. A bruise from external 
violence, presents all the objective symptoms 
of a purpuric spot, and the tiny ecchymoses 
resulting from the bites of fleas are of the same 
general type, as far as outward appearance 
goes. Text- book authorities have classified all 



12 PURPURA. 

these conditions under the title purpura. Thus 
the ecchymoses from flea-bites are called pur- 
pura pulicosa ; those from external violence, 
purpura traumatica ; those accompanying 
scurvy, purpura scorbutica ; those from blood- 
changes induced by corrosive drugs, purpura 
toxica ; those occurring in malignant cases of 
smallpox, purpura variolosa; and so on, in 
variety too numerous to mention. Now, it is 
quite evident that such designations are mis- 
leading as they group together, under a generic 
name, unrelated disease-conditions, quite 
irrespective of etiological or pathological sig- 
nificance. If purpura is merely a local haemor- 
rhage, or a series of local haemorrhages, then 
it does not deserve to be classed as a disease, 
but is only a symptom, and the word purpura 
should be dropped from our nomenclature. 

Although none of the conditions designated 
above possess the qualities which entitle them 
to be set aside into a group of cases by them- 
selves, to which we might with propriety apply 
the term purpura, there are groups of symp- 
toms, indicating a morbid action of a definite 
character, but varying very greatly in intensity 



DEFINITION. 13 

in different individuals, to which the term may 
be appropriately given. From this class will 
be excluded all the conditions heretofore des- 
ignated, not only because they do not present 
any definite etiological or pathological simil- 
iarity, but because these all occur as epi-phe- 
nomena, and not as in true purpura, where the 
extravasation is the pivotal, or key-note, symp- 
tom of the case. We do not, therefore, include 
in the definition of purpura, the effects of 
internal or external violence, the action of 
poisons, or the results of specific or contagious 
diseases. 

Purpura is a somewhat rare disorder. Seventy 
American and British homoeopathic physicians, 
who have each been in continuous practice for 
upwards of twenty years have only treated one 
hundred and forty-nine cases of the hemorrha- 
gic variety in all ; and yet these were selected 
from among the entire homoeopathic fraternity 
as the ones most likely from their hospital 
connection, and otherwise, to have been brought 
in contact with this disorder. And of thirty- 
four other physicians, who had been in practice 
an average of ten years, only seventeen had 



14 PUKPIJEA. 

seen a case of hemorrhagic purpura, and but 
three of these had seen more than one. Still 
while purpura is by no means common, especial- 
ly in its severer forms, every practitioner is 
liable at any time to have such a case presented 
to him for diagnosis and treatment. Only a 
few years ago, three prominent physicians in 
this city diagnosed a case as hemorrhagic 
smallpox, which to their confusion, proved to 
be, on postmortem examination, purpura. 

Purpura, when fully developed is one of those 
unique diseases, which from its striking physical 
manifestations, takes a firm grasp upon the 
imagination of the beholder, and arouses 
consternation in the family of the sufferer. 
Human blood, even when the quantity is 
insignificant, is an object of terror to the general, 
and the doctor who can make a brillant cure of 
such a case, is already on the high road to 
professional success. 

ETIOLOGY. 

The cause of purpura has never been definitely 
determined. It occurs under diversified condi- 
tions, and all these have been in turn assigned 



ETIOLOGY. 15 

as causes. Impure air, damp or miasmatic 
lodgings, improperly prepared or scanty food, 
fatiguing and laborious occupations, or intem- 
perance cannot reasonably be assigned as causes, 
though purpura is often consecutive to these ; 
yet many live among the most deleterious 
surroundings, never know what it is to have a 
decent meal, never recover from the fatigue of 
one day before compelled to begin the labors of 
the next, or imbibe to degradation and by 
continuous habit without inducing a vestige of 
this disorder. Jaundice, acute rheumatism, 
the exanthemata, and menstrual derangements, 
may each be followed by purpura, and are so 
followed in proportion of frequency to the 
order here named ; but then, it also occurs in 
persons apparently in good health, and in those 
who have not been exposed to any debilitating 
influences. Jaundice and purpura are so 
frequently associated, that the older writers, 
who were fond of giving names to things, and 
who seemed to be impressed with the idea that 
as soon as they had labeled a disease they had 
accomplised all that could be reasonably 
expected of them, used the term purpura 



16 PURPURA. 

hepatica. Irregularities of menstruation cannot 
be classed as a cause of purpura, although it is 
a frequent concomitant of amenorrhcea. It is 
more than probably that both are symptomatic 
and not causative. It would seem in some of 
these cases as if the purpura was of the nature 
of a vicarious haemorrhage, as the purpuric 
patches have been known to disappear as soon 
as menstruation was established. Almost any 
of the chronic alterations in the viscera may be 
associated with purpura, more especially 
amyloid changes. It has been claimed that 
purpura depends upon some minute organism 
in the blood. Thus Watson Cheyne describes 
a plugging of the capillaries with masses of 
bacilli 1 ; and Petrone injected hypodermically 
into rabbits blood drawn from purpuric patients 
and thus produced widely distributed haemorr- 
hages. 2 It must be admitted that this would 
be a very convenient theory, from the fact that 
no other immediate cause of the disease is 
known ; but unfortunately for its value as a 
theory several varieties of micro-organisms 

lZiemssens' Cyclopcedia, xvii, 258. 
2L0 Sperimentale, 51, 1883. 



ETIOLOGY. 17 

have been described as thus occurring. This 
throws much doubt on the whole matter, and 
still leaves the question wide open. 

Purpura occurs in both sexes, and at any 
age, but is most frequent at the extremes of 
life. It might be easily confused in childhood 
with hsemophila ; l)ut purpura is not hered- 
itary, and generally occurs suddenly, without 
previous haemorrhages, while hsemophila can 
be easily diagnosed by the family history and 
the previous occurrence of haemorrhage. The 
hemorrhagic diathesis is more likely to afflict 
the female members of the family, but there is 
no such difference in the attacks of purpura. 
The only reason why purpura seems more 
particularly a disorder of childhood and senility 
is, that in the very young the tissues of the 
capillaries are extremely thin and soft, and in 
the aged they are very brittle, and so in both 
cases fracture is more probable than in those of 
mature but vigorous life. A. diet of salt meat, 
or an absence of vegetable food, has no influence 
in causing purpura ; this sufficiencly dif- 
ferentiates it from scurvy, and shows the 
inappropriateness of the term Icuid-scurvy 
which has been applied to it. 



18 PURPURA. 

Not only is there obvious confusion as to the 
cause of the haemorrhage in these case, but 
there is likewise the same uncertainty as to 
how it is brought about. The escape of blood 
blobules from the capillaries, may take place 
by transudation without, rupture of the 
capillary tissues ; but even this presupposes 
some change either in the capillary or in the 
blood. At one time the disorder was ascribed 
to debility in the heart's action, and to defective 
nutrition of the circulatory system ; but it is 
evident that this cannot be a prime cause as 
extreme cardiac debility may exist for many 
years, and cause death, without purpura 
developing. Nevertheless, anything which 
tends to prevent ample nutrition of the lesser 
blood-vessels would facilitate the development 
of this disorder. As a rule, there must be some 
degenerative change in the capillaries, which 
makes them especially liable to give way under 
blood-pressure, although the initial morbid 
disturbance may have been in the blood itself. 
Dr. Wilson Fox has observed a case in which 
the capillaries were in process of lardaceous 
defeneration.' He observes, in regard to this, 



E T I O L o a Y . 19 

as an explanation as to the manner in which 
purpura may arise : " Another very important 
question is, how far this affection of the 
capillaries can be logically considered to have 
been the cause of the haemorrhage. Any direct 
association of the two changes will probable be 
considered doubtful by many who know that 
lardaceous affections of tissues are rarely 
associated with haemorrhage : and further, 
that the changes in the parenchyma of organs 
and in mucous membranes thus affected is often 
preceded by a similar change in the smaller 
vessels 1 . The evidence as it stands at present 
is decidedly against such a theory of causation, 
unless one or two hypotheses may be admitted 
to explain the connection of the phenomena 
observed. (1) May this lardaceous degener- 
ation, which we know chiefly as a chronic 
disease, occur occasionally in a more acute 
form, and in this manner so rapidly alter 
the elasticity of the vessels, before their 
diminished calibre can have retarded, the flow 
of blood in the part, that rupture and 

iVirchow, Cellular Pathology, page 374. 



20 P TT P P TT P A . 

hemorrhage ensue ? (2) Is it possible that 
this lardaceous change, occurring only in tracts 
of tissues, may throw such a stress on the 
collateral capillary circulation of the tissue 
around, that adjacent but comparatively 
unaffected capillaries give way \ Both theories 
derive some support from the observations 
made on the dissemination of the degeneration 
in this case, and also from the observations of 
Zenker, in a similar degeneration of the muscles 
in typhoid fever/' 1 

Purpura has been artificial induced in a 
variety of ways. Simon has produced it by 
dividing some of the sympathetic ganglia in 
the neck of the frog ; softening of the tissues 
first occurring (Hilliard). It is possible that 
this fact may bring us very near the correct 
explanation. As there is no constant condition 
of the blood, or of the circulatory organs, or of 
tissues immediately affected by the extravasa- 
tion, which points surely to this disorder, it 
may well be that the cause back of all may be 
some abnormal state of the sympathetic nervous 

i Ueber die Verdnderuuyeu der willkuhr lichen Muskeln in 
Typhus Abdominalis. Leipeig, 1864. 



ETIOLOGY. 21 

system. Thus Da Costa says that as the disease 
comes on frequently in the midst of seemingly 
excellent health, it cannot be merely a disease 
of the blood, but is possibly the result of im- 
paired power in the capillaries, through that 
part of the nervous system that controls them 
— the vasomotor system. 

Many drugs cause purpura : some of these 
pathognomonically. and others only in special 
cases, or particular individuals Tilbury Fox 
has shown that the injection of ammonia into 
the veins will cause extravasations of blood 
into various parts of the cutaneous surface, and 
haemorrhages from the mucous membranes. 
Virchow injected putrescent matter into veins, 
and saw resulting therefrom ecchymoses of the 
endocardium, of the lungs, liver, kidneys, and 
intestines. 1 Dr. Parkes has shown that an 
excess of iron in the blood tends to produce 
purpura : but this observation is of little prac- 
tical importance, as in a multitude of other 
instances it has been shown that the blood of 
purpuric patients does not contain an excess of 

i Quoted by Tilbury Fox in Reynold's System of Medicine, 
Vol. I, page 466. 



■HMHI^HB 



22 PURPURA. 

the ferric salts. Indeed almost every one of the 
natural constituents of the Wood have been 
found normal, excessive, and deficient in vari- 
ous purpuric patients ; thus proving absolutely 
nothing. 

Frerichs has suggested that there is an 
abnormal attraction between the capillaries and 
the blood, from whence arise obstruction and 
rupture. This is somewhat like Watson 
Cheyne's theory of the plugging up of the cap- 
illaries with bacilli ; but both propositions are 
wanting in real, good, solid facts to stand on. 
Hebra is of the opinion that temperature and 
clothing have much to do with the production 
of this disorder ; but this also seems a mere 
tanciful idea. Climate really has little or no 
influence on the development of this disorder. 
In fact, nothing positive can be advanced, the 
more careful the observer the more cautious 
his utterances, and while many theories have 
been discussed nothing definite is known of 
the cause of the disease of which cutaneous 
haemorrhage is the visible evidence. 

PATHOLOGY. 

Pathology gives us very little definite infer 



PATHOLOGY. 23 

mation. Tt does tell us that these discolorations 
are real extravasations of blood into the cuta- 
neous tissue, and not merely the leaking 
through the capillary wall of the coloring 
matter ; that sometimes these hemorrhagic 
are quite extensive, invading the contiguous 
tissue of an entire limb; that in many cases 
they extend into the subcutaneous cellular 
tissue or even into the muscular structure ; that 
they very frequently invade the mucous and less 
frequently the serous tissues, and that there 
may be not only ecchymoses upon these, but 
actual haemorrhages, debilitating in severity or 
frequency, from the nasal passages, the buccal 
cavity, the pharynx, the stomach, or the intes- 
tines, and into the sacs surrounded by the 
pleura, the pericardium, or the peritoneum. 
Post-mortem examination usually shows the 
lun^s and brain to be in a normal condition ; 
the liver may be healthy, or it may be fatty, 
atrophic, or cancerous ; the spleen may be 
natural in dimension and consistence, or it 
may be hypertrophic or indurated ; the pelvis 
of the kidney often contains blood, and its 
parenchyma may be normal, or show amyloid 



24 PURPURA. 

or other form of degeneration ; the capillaries 
of the skin have been observed to be degenerate 
from amyloid changes, and in other cases have 
been pronounced healthy ; while the general 
mass of the blood is in some cases entirely 
normal in appearance and characteristics, 
coagulating readily, and in other cases it is 
unusually fluid, and indisposed to coagulate. 
The white corpuscles have been seen to form a 
considerable proportion of die blood, and, 
again, they may be abnormally infrequent. 
And, finally, as stated by various observers, 
the fibrin may be excessive, deficient, or in 
due proportion. Thus there does not seem to 
be any recognized pathological change in this 
disorder, except the ecchymoses themselves, 
sufficiently constant to be determinate, or even 
indicative. But it by no means follows that 
there are no definite changes which take place 
in ordinary, uncomplicated purpura, and the 
confusion on this point has arisen mainly, if 
not wholly, from the fact that the cases which 
have been particularly studied were ones in 
which the purpuric condition was associated 
withother grave disorders. Thus the Wilson Fox 



SYMPTOMS. 25 

case, of which so much has been said, was a 
very unfair specimen of purpura, as the man 
was far advanced in secondary syphilis, with 
severe ulceration of the pharynx and larynx, 
and with amyloid degeneration of the spleen, 
liver, kidneys, and intestines. Dr. Dickinson's 
first case was one of meningeal apoplexia, in a 
cachetic subject, who died on the third day of 
the attack. The second case was one of jaun- 
dice caused by the pressure of a hydatid cyst. 
Nothing of appreciable value can be learned 
from such cases, and I have been unable to find 
anywhere clear records of necropsies in cases 
of uncomplicated purpura. 

SYMPTOMS. 

Purpura may abruptly appear in persons of 
apparently robust and vigorous health ; or, it 
may be preceded for several days by malaise, 
headache, nausea, drowsiness, and pains in the 
back and limbs. If with this there is some 
elevation of the bodily temperature, the case 
will closely resemble the prodromal period of 
the exanthematous fevers. The purpuric spots 
or patches usually begin on the thigh, although 



26 PURPURA. 

they may appear on any part of the cutaneous 
surface, or be so broadly sown as to have the 
appearance of having come out all over at once. 
In either event, the spots may differ greatly in 
size and outline. They may be stigmata or 
mere points, which unless very numerous are 
apt to escape detection. If the size vary from 
that of a pin's head up to that of a split pea, 
they are called petechue. Larger patches are 
termed ecchymoxes* unless they are long and 
narrow, resembling the black-and-blue whelt 
caused by the stroke of a whip, when they are 
known as ribices. When these various shaped 
spots first appear, they are usually definite in 
outline, but as the spot ages the margin gradu- 
ally becomes indistinct, and the eye is unable 
to precisely determine where the ecchymosis 
ends and healthy tissue begins. This may be 
caused either by the gradual extension of the 
patch, involving new tissue, or by the 
absorption of the extravasated luematin. 
Almost always, at first, not only is the 
definition of the outline of the patch abrupt, 
but it presents a certain geometric regularity. 
But in severe cases, these patches are apt to 



SYMPTOMS. 27 

spread, by continued haemorrhage, and they 
then look just like an ordinary bruise. Tbe 
color varies according to the age of the spot. 
At first it is bright-red, like a place that is 
about to blister ; then it deepens through the 
crimson tints to violet, becomes deep purple, 
and at last blackish. Occasionally the 
erythematous stage is preceded by subcutaneous 
induration or oedema, as in the specific 
exanthema tons diseases These various stages 
may develop sedately, or follow upon each 
other s heels so quickly as to ripen in a single 
night. Id ordinary cases, each spot lasts about 
two weeks, fading gradually like an ordinary 
bruise. In a case, therefore, which has lasted 
for some days, the purpuric spots will be seen 
in all stages of development and degeneration. 
In more severe cases, the extra vasa ted blood 
may not be reabsorbed, and local gangrene may 
occur. It is in such cases, marked with 
unusual severity or extent of the haemorrhage, 
that blood-stained fluid escapes in sufficient 
amount beneath the cuticle to cause blebs; this 
has been termed purpura 'pemphigoides. If 
the disorder is limited to the cutaneous surface, 



28 PURPURA. 

there is little danger to, and moderate 
disturbance of, the general health ; but when 
the mucous or serous surfaces are involved the 
case becomes at once most grave. This form of 
the disease is called purpura liwmorrhagica. 
It differs only from the simple form in being 
more extensive, but the mucous involvement 
produces haemorrhages from the parts affected 
— epistaxis, buccal bleeding, hsematemesis, 
hematuria, malsena, or haemoptysis, as the 
case may be— and these are often profuse, 
long-lasting, and exhausting. The following 
case is typical, barring the apparently inherited 
tendency to haemorrhage ; and is reproduced 
here from the American HomoeopatMst, of 
August, 1885, as a fair sample of a severe but 
not by any means necessarily fatal type of this 
unique disorder. It was reported by Dr. J. W. 
Angell, of Iowa Falls, Iowa. 

" December 7, 1884. Was called to visit Miss 
Addie H., aged 17, a daughter of one of my 
patrons, living here in the city, and was, there- 
fore, well acquainted with the young lady. 
She was a well developed young woman, pos- 
sessed of a lively, pleasant disposition, quick 



SYMPTOMS. 29 

perception, black hair, dark eyes, with a clear, 
but always of a rather pallid, complexion. 
Menstruation, since its first appearance, in her 
fourteenth year, had never been quite regular, 
frequently too soon, too profuse, and some- 
times quite painful, and then again delayed 
beyond the fourth and fifth weeks : was quite 
subject to severe attacks of headache, confining 
her to the bed for hours at a time. Quite often 
troubled with epistaxis, as also was her mother 
when at her age. Bowels regular, and kidneys 
performing their functions properly. Digestive 
organs all healthy, and to all appearances Miss 
Addie enjoyed as good health as do the major- 
ity of girls of her age, and of American parent 
age, as was hers. Her residence is located on 
a lot adjoining a deep ravine, which is filled 
with brush and brambles, always moist, as it 
serves to carry off the surface water and re- 
ceives the underground drainage of a number 
of the surrounding lots in that vicinity, while 
the yard around the house contains many fruit, 
as well as native trees. The family has had 
considerable sickness since residing there, 
which has been for several years, and Miss 



30 P IT R p TT K A . 

Addie had diphtheria three years since, and, 
during an epidemic of scarlatina, two years ago, 
her younger brother and sister were attacked 
with it, and her brother died of it. During 
the two months preceding the attack of her 
last sickness she had been more than usually 
troubled with headache, but still attended 
school and kept up with her class in her studies. 
Some time in November last, she was severely 
troubled by an eruption upon various parts of 
the skin, of an irritating character, resembling 
eczema simplex, but only upon one thigh, just 
above the knee, did it give her very much 
trouble. There, it seemed to assume the char- 
acter of small "blood boils," which gave her 
considerable pain. To these little boils, she 
applied a wash that is quite popular here, for 
the cure of all kinds of skin diseases, the princi- 
pal ingredient of which is corrosive sublimate, 
and its first application caused her to suffer 
intolerable pain, not only from the u boils," 
which became very much swollen, but all 
through the limb, up the whole length of the 
spine, and through the head, and exciting a 
feverish condition throughout the whole system. 



8YIPTO M S . 31 

These symptoms continued for a day or two, 
and then subsided, leaving those sore spots on 
the limb apparently better, as they were dried 
up, and not very painful. But in a day or two 
after she was surprised to notice the appear- 
ance, on nearly all parts of her skin, of an 
eruption of little red spots looking like Ilea, 
bites, from some of which, especially upon the 
back of her hands and lingers, would ooze a 
drop or two of blood ; and with these red spots 
w T ere many larger ones, dark and discolored, 
just like blood' blisters, some of them as large 
as a clime. None of these sf>ots upon the sur- 
face gave her any pain, nor felt sore upon 
pressure. These would disappear in a few 
hours, and then again reappear, as numerous 
as ever. 

A day or two fiom the first appearance of 
this eruption upon the surface, it appeared also 
in the buccal cavity, on her tongue, cheeks, 
lips and gums. Then she began to have fre- 
quent attacks of bleeding froin the nose ; sev- 
eral of them quite profuse, the blood flowing 
mostly from the right nostril. This state had 
continued for several days before I was called, 



32 PURP UK A . 

for, as she otherwise was feeling quite well 
having a good appetite, bowels regular, 
sleeping well at night, with only a little dizzi- 
ness of the head once in a while, her mother 
thought it not necessary, and therefore made 
use of such remedies to restrain the nasal haem- 
orrhage as are so often effectual ; and thinking 
Addie was only going through a similar trouble 
to what her own had been at her age, did not 
think it necessary to resort to medical assist- 
ance. But, these frequent and profuse haem- 
orrhages from the nose persisting, and then the 
appearance of those blood blisters in her mouth, 
together with frequent darting pains of the 
head, told her that Addie was suffering from 
no ordinary complaint, and was in need of 
other treatment and remedies than she was 
able to give her, and, therefore, called me to 
her assistance. 

I found her on the morning of December 7th, 
sitting in her easy chair, busied with needle 
work, and in good spirits, cheerful and pleasant, 
as was her usual mood, but with an unwonted 
pallor to her countenance, which shocked me 
by its intensity. 



SYMPTOMS. 33 

I then learned the history of the case, as I 
have just related it, with the further one that 
she had noticed for several weeks previous. 
Whenever she. happened to merely prick 
herself with a pin, the blood would flow from it 
freely, and would do so for a long time before 
she could stop it. There was no difficulty in 
diagnosing the disease affecting her, but in 
answer to the question her mother put to me 
of, "What ails her, doctor?" I replied, " blood 
poison." I did not hesitate to give her a 
favorable prognosis, though I was fully 
impressed with the idea that this my third case 
of purpura hemorrhagica, was of far more 
doubtfulness as to its favorable termination than 
had been the two previous ones occuring with 
me in the early years of my practice, and 
while following that of my allopathic education. 
Those cases occurring in the malarial climate 
of Michigan, yielded to the influence of quinine 
and nitric acid, and why should not this ? I, 
therefore, prescribed those remedies, together 
with powered hamamelis. to be snuffed up the 
nostril, when bleeding. I found her pulse, 
beating 65, soft and sluggish, some pain in the 



34 PURPURA. 

head, tongue coated with a dirty brown fur 

through the middle, but moist, with a large 

blood blister upon the inner side of one cheek, 

and on numerous parts of her arms and limbs 

those dark spots, and numerous little red 

pimples. Also, blood oozing from the gums of 

the lower front teeth. I also gave a wash of 

hamamelis for the mouth, with sulphate of 

quinine, one grain every two hours in alteration 

with nitric acid, 3x, 10 drops in half tumbler 

• 
water. At my next visit I found no material 

change in symptoms, except that the hamamelis 

had checked two attacks of nose bleed through 

the night, and that the blood blister on the cheek 

had disappeared. Pulse a little stronger and 

fuller. Ordered the same remedies continued. 

with free use of lemonade as a drink, and as 

her appetite was good, permitting her to 

partake freely of broiled beafsteak. Bowels as 

usual had moved freely during the morning. 

At my third visit learned she had had a profuse 

flow of blood from the nostril during the night, 

which hamamelis did not check, and, also the 

oozing from the gums was steady, and from 

several of these little red spots upon her 



SYMPTOMS. 35 

forehead was oozing a little blood ; pulse SO, 
and weaker, more darting pains through her 
chest, and a steady ache all along the spine ; 
but still she was up and dressed, and enjoyed 
her food as usual ; evidently the disease was 
not yielding to the remedies. Omitted the 
quinine and nitric acid, and gave terebinthina, 
6x, with phosphorus 12x, every hour in 
alternation, through the day, and with tannic 
acid as a styptic to the nostril. My next visit 
found an improvement in most of the symptoms 
as there had been no bleeding, and there was a 
better appearance of the tongue and mouth 
with a stronger pulse, and no new spots of 
ecchymosisupon the skin ; had slept well ; con- 
tinued the same treatment, 

My fourth visit, on the 11th, found her with 
the symptoms of the previous day unclianged, 
and thereupon ordered a continuance of the 
same potencies of terebinthina and phosphorus, 
and tannic acid, when needed. On the 12th 
was informed that there had been two attacks 
through the night of "nose bleed," which the 
application of tannic acid did not control, as it 
had previously done, and there was another 



36 PURPURA. 

" blood blister" covering nearly one-half of 
the right side of the tongue ; and from the gums 
a steady oozing, with a cadaverous odor of 
breath ; pulse 85 and fluctuating. She also 
complained of more pain in her back and head, 
with a great sense of weakness in the morning 
when she first awoke, almost to faintness, but 
that left her as soon as she drank a cup of tea, 
and took nourishment, which she still relished 
as heartily as ever. Was up and dressed and 
was as cheerful and pleasant as usual ; bowels 
still regular in all their functions, and so, too, 
apparently, were the kidneys. Evidently this 
case was not disposed to yield to any of the reme. 
ies I had used thus far, neither to the allopathic 
nor homoeopathic, and I began to feel uneasy as 
to its finale. I can find but one single case of the 
kind reported in any of the medical journals of 
the homoeopathic school that I possess, and 
that is the American Homaiopathist, No. 2, 
Vol. 7, 1881, reported by H. Detwiler, M. D., 
which yielded apparently to terebinth ina 6x, 
which in this case failed to produce any effect. 
The slight references to this disease and its 
indicated remedies, by Jahr, Raue, Hunt and 



SYMPTOMS. 37 

Marcy, are all so unsatisfactory that I did not 
feel much confidence in selecting any remedy 
mentioned by them, and as those I had used 
failed to respond to my expectations. I resorted 
again to Jahr's Symptomatology to find a guide. 
Cro talus horridus having so many of the 
symptoms in its pathogenesis that were present 
in this case, I determined to give it a trial, and 
prescribed the 6th, 10 drops in half tumbler of 
water, a teaspoonful every hour, with a wash 
for the mouth of ferri sulph., 10 grains to a 
pint of water. At my next visit I was satisfied 
with the apparent effects of my last remedy, as 
there had been no return of epistaxis and the 
buccal cavity was free from spots of ecchymosis, 
and oozing from the gums and also the petechial 
and ecchymotic eruption had disappeared from 
the skin ; pulse 80, not much pain in head or 
back, but still that faintness in the morning 
till food was taken, and that dizziness upon 
raising from the pillow or raising from her 
chair. Had rested and slept comfortably all 
night with her usual relish for tea, toast and 
beefsteak for breakfast, and the bad odor of 
her breath was not so perceptible. And though 



38 purpura. 

I had noticed equal improvement once or twice 
while using previous remedies, which was soon 
lost, yet I felt quite sure that I had found the 
right remedy, and so continued it. 

She had now been under my treatment eight 
or nine days, and for the last two under the 
use of crotalus, which, seemingly, was control- 
ing her disease. I therefore left her on the 
17th of the month, still using the same remedy, 
but at much longer intervals, and fully per- 
suaded that she w r ould need no other. Calling 
upon her again on the 20th was disappointed 
to learn that she had been troubled almost 
ever y night since my last call, with more or 
less epistaxis, though not to any great extent, 
but sufficient to create uneasiness in my mind, 
as it told me that the hemorrhagic dyscrasia of 
her system was still persistent. No more of 
that petechial eruption had made its appearance, 
nor was there any perceptible change in any 
other of the symptoms ; bowels still regular, 
rest and appetite good, and her spirits as lively 
and cheerful as ever, but the dizziness persisted, 
with more or less pain along the spine and 
through the head. I ordered the medicine, 



SYMPTOMS. 39 

crotalus, to be given every two hours, with a 
continuance of the mouth wash of ferri sulph. 

The next day found the pulse 85, no bleeding 
from nose or gums, but a slight reappearance 
of the ecchymotic eruption. Ordered ledum 6x, 
10 drops in one-half tumbler of water, to be 
given in alternation with crotalus. On the 22d 
found her symptoms again better, and made no 
change in the prescription of crotalus and 
ledum. 

The next day, the 24th, I found her 
about in the same condition that she had 
been for two days previous, and seem- 
ing convalescent. Ordering a continuance 
of the same remedies, but at longer 
intervals, left her thinking I had finally con- 
quered her disease. On the evening of the 2oth 
her father came to me with the report that 
" Addie was too free with her monthlies, that 
had come on that day, a week before her time," 
and asking " what she had better take to check 
them V ' I sent her viburnum opulus tincture, 
20 drops to 4 ounces of water, a teaspoonful 
every half hour, and if, after the 5th dose there 
was no change, to give her in addition cinnamon 



40 PURPURA. 

tea to drink of freely. Calling upon her the 
next morning at 8 o'clock, I was shocked to see 
the change that had taken place in her appear- 
ance since my last call on the 24th. Lying in 
bed, with a face as void of color as was the 
pillow on which it lay, apparently bloated, 
eyes sunken and dull, no longer lively, but 
stupid and drowsy, with pulse beating 130, 
weak and fluctuating, skin hot and dry, tongue 
with a dry, black coat, great pain through the 
head, throbbing in the temples and down the 
spine, and at intervals, severe uterine pains, 
with a steady flow of dark blood from it, and 
gushing at every movement of the body. The 
hemorrhage had been as copious from its first 
appearance at 3 o'clock p. m., of the day before 
as is usually met with in cases of child-birth, 
and the remedies I had ordered, though us^d 
faithfully, had not checked its flow in the least. 
Evidently the first indication was to check 
that haemorrhage. For that purpose I gave 
her five drops of erigeron oil, upon sugar, and 
ordered, it to be repeated every hour till a 
change or improvement should be seen, and 
then in drop doses until my return. At 12 M. 



SYMPTOMS. 41 

I saw her again and found the flow had very 
greatly diminished during the "last two hours, 
and therefore continued the drop doses of eri- 
geron at every two hours. Calling at 5 p. m., 
was satisfied with the action of the remedy and 
continued it at longer intervals. Pulse 135, 
temperature high, pain in head, back and 
hypogastric region, very severe, with great 
thirst. Ordered aconite 3x, four pellets each 
hour. She did not take the erigeron. Next 
morning at eight o'clock saw her again, with 
symptons more encouraging, pulse down to 90, 
low x er temperature, less •hemorrhage but tongue 
still dry and black ; had rested well after 
twelve o'clock, less headache, with no pain in 
back or bowels ; had taken nourishment and 
with some relish. Continued the same treat- 
ment. At my evening call, at five o'clock, 
found a return of all the feverish conditions of 
the day before, but with a diminished flow 
from the uterus, except when she moved, then 
it gushed from her, but not so much. I reduced 
the quantity of the erigeron, and in alternation 
with aconite gave bryonia, as she was calling 
for copious draughts of water, and with some 



42 PURPURA. 

pain through the chest. The next morning her 
fever was lower again, and thus kept up for 
the next six days the morning remission, with 
exacerbations in the afternoon and evening. 
Pulse in the morning always about 90 and up 
to 130 in the evening. Not having a clinical 
thermometer I can not give the exact temper- 
ature, but was sure that it was above 102° at its 
highest and never in the morning below 100° ; 
tongue covered with a dark dry coat at all 
times with a red tip and edges, and after the 
fifth day with soreness of teeth and gums ; 
much thirst, torpid bowels and scanty urine, 
with brick dust sediment. The menorrhagia 
steadily decreased from day to day, till on the 
ninth day the fever had subsided under the 
continued use of rhus 6x and baptisia 2x in 
alternation, when that entirely ceased and with 
no return of either nasal haemorrhage or 
petechial eruption, I flattered myself that my 
patient was now convalescent again, and with 
a return of strength would in a short time be 
fully restored to health. With the subsidence 
of fever her appetite returned, bowels and 
kidneys became regular, and for several days 



SYMPTOMS. 43 

she seemed to be regaining her strength as fast 
as one could, convalescing from such a high 
grade of fever as hers had been. Only one 
symptom continued to give me uneasiness and 
that was her extreme prostration to almost 
perfect syncope when first waking in the 
morning, but that would subside immediately 
upon swallowing a little tea with a mouthful 
of toast. 

I watched her closely from day to day, but 
as no other symptoms except that and a too 
quick pulse, as high as SO always, and some- 
times higher, only indicated a want of strength, 
I did not feel doubtful of overcoming that want, 
and ordered arsenic 12x, four pellets three 
times -a day, together with as nourishing a 
diet of broths, buttered toast, and rich sweet 
cream as her stomach would bear ; and as that 
organ seemed perfect! y sound, there was no 
difficulty in that respect. In a few days more 
she had so far regained her strength as to 
enable her to be dressed and moved from her 
bedroom. Calling upon her on the 12th of 
June I was disturbed to find again that oozing 
from the lower gums and on her tongue another 



^^^^HHH 



44 PURPURA. 

of those large blood blisters, with other 
indications of that old hemorrhagic dyscrasia, 
which I had supposed was entirely subdued 
and would no longer trouble her. Aside from 
this, her symptoms were all satisfactory save 
that continued morning faintness and the 
quick, soft and fluctuating pulse of 85. She 
was sitting up fully dressed and with her 
usual flow of cheerful and happy spirits, with 
a good appetite and quiet and restful sleep 
every night. I ordered cro talus to be given in 
alteration with arsenic. On the 14th I found 
that oozing from the gums and the blister on 
her tongue had left her, but the night before 
she had a slight return of nose bleed, the first 
in over two weeks ; other symptoms about 
the same. Continued the same remedies. 

On the 15th her symptoms were more 
encouraging, so, also on the 16th and 17th, 
when upon visiting her in the morning of the 
latter day found her at the breakfast table 
enjoying a hearty meal and so apparently out 
of all danger that, after ordering for her a 
tonic in the form of fl. ex. hydrastis, 4 drachms 
and 1 drachm of coca leaves to a pint of water, 



SYMPTOMS. 45 

a tea-spoonful to be taken before each meal, I 
dismissed the case, as I thought, cured. Soon 
after I left she complained of a severe headache 
and retired to her bed. That evening the 
menstrual how came on again very freely and 
with great pain along the back and over the 
hypogastric. Before morning the flow was 
excessive, and her mother gave her five drops 
of erigeron oil and repeated it in two hours. I 
saw her again at eight o'clock on the morning 
of the 18th and found her in great distress, all 
through her system, with the nienorrhagia 
worse than ever. As the erigeron had not 
checked it, I gave her fifteen drops of fluid 
extract of ergot, and repeated the dose in 
one half hour. This checked the discharge. 
Pulse up to 140 and feeble. Tongue again dry 
and heavily coated. In the evening I gave 
muriated tincture of iron, 10 gtts. in half a 
tumbler of water every thirty minutes, and 
continued it through the night. On the 19th 
there was less menorrhagia and less general 
distress, but great weakness and frequent 
fainting spells, and at times great nausea. 
Gave ipecac 5 gtts. in half a tumbler of water 



46 PURPURA. 

and viburnum in alteration. On the 20th an 
improvement was apparent till evening, when 
again another spell of nose bleed reduced her 
very much. 

On the 21st found her extremely weak and 
discouraged, the menorrhagia still keeping up 
but not excessive, her pulse 140 with dry hot 
skin, tongue dark, dry and trembling, bowels 
torpid and tender upon pressure, great restless- 
ness and thirst, but less nausea. Continued 
the ipecac and viburnum at longer intervals. 
That night another attack of epistaxis set in 
and was persistent for several hours. Found 
her on the morning of the 22d still suffering 
from the last attack, Avith the pulse still higher 
and fluttering, with all the symptoms of 
dissolution increasing rapidly. At this point 
her parents decided to call in an allopathist 
and place her in his care, and I was relieved 
from further attendance upon the case ; and I 
must confess that I was not very deeply grieved 
at their decision, though I thought there was 
still a possibility if not a probability of her 
ultimate recovery. But she had become 
discouraged and desired to change, and as I 



SYMPTOMS. 47 

had lost her confidence, it was better for her 
that some one else should be called in. Under 
the inspiring influence of hope she rallied for a 
few days and all were encouraged at the 
improvement of her symptoms, but they were 
not lasting and death closed the scene on the 
4th of February ; no post-mortem. examination 
was held." 

This case is not presented as a good example 
in therapeutics. It was thus commented upon, 
editorially, in the issue of the journel in which 
it flrst appeared. 

Reviewing the case as it was seen by Dr. 
Angell on the morning of December 7. there is 
one remedy which seems to stand out so plainly 
indicated as to be unmistakable. The temper- 
ament of the patient, — black hair, dark eyes, 
clear, pale complexion, vivacious disposition ; 
the inherited tendency to haemorrhage — 
resembling her mother in this ; the frequent 
headaches and the present dizziness ; the 
menses, as a rule, too early, too profuse, and 
of too long duration, with colic and pains ; 
tlie eczema succeeded by blood-boils upon the 
skin and blood-blisters in the buccal cavity ; 



48 PUTCPUKA. 

the severe haemorrhages from the nose ; and 
the copious and prolonged bleeding from small 
wounds — taken together form a vivid picture 
of Phosphorus. 

Unfortunately, Dr. Angell, yielding to the 
influences of his allopathic education, gives not 
the remedy denoted by the law of similia, but 
a course of remedies based upon their successful 
use in other cases, amid other surroundings, 
and which experience proves to him must 
have had pathological factors other than the 
case in hand. 

A half drachm or more of quinine seems to 
have been given with negative or perhaps even 
deleterious influence ; as the case grew steadily 
worse ; a less amount of the drug has been 
shown to cause purpuric spots, when given in 
febrile states (Vepau). Just how much the 
subsequent intractability of the case may have 
been due to the secondary effects of the drug 
cannot now be determined. 

Phosphorous 12, on the lOthinst., was a good 
prescription, only it was days too late ; but 
what can we say of the turpentine ? A careful 
study of the pathogenesis of terebinth ina 



SYMPTOMS. 49 

fails to reveal a single indication for it in this 
case. There are cases of purpura in which it 
does good. Prof. Comstock, of St. Louis, has 
reported such an one in the North American 
Journal of Homoeopathy, 1861, and this is 
reproduced on another page. The action of 
turpentine upon the blood is just the reverse of 
phosphorus, crotalus and lachesis. In physi- 
ological doses it increases the coagulability of 
the blood, while all the indications in this case 
point to a morbid fluidity of the blood ; tur- 
pentine was, therefore, homceopathically, 
contra-indicated. In large doses it might have 
done some good ; but the sixth decimal !— was 
merely playing with fire. In a case of purpura 
with disordered digestion, tympanites, hema- 
turia, dryness and burning of the mucous 
membranes, headache with flushed face and 
violent thirst, emaciation with dropsy, terebin- 
thina, in one of the higher potencies, would 
doubtless prove curative. 

The improvement which seems to have set in 
as the result of phosphorus 12, did not continue 
long, and we can only conjecture why. Cer- 
tainly if the turpentine and the tannic acid 



50 PURPURA. 

had any influence, it was merely as antidotal 
to the therapeutic power of phosphorus. 

Cro talus is a valuable remedy in purpura. 
Dr. J. W. Hayward has given two cases cured 
by it ; they will be found under that rubric; 
and t-he pathogenesis of the drug seems to ally 
it more closely to this disorder than any other 
drug in the materia medica. The mental con- 
dition of this patient was, however, very unlike 
crotalus. • The crotalus patient is anxious, 
agitated, stupid, and struggles with mental 
delusions and hallucinations ; but we have here 
a girl who is bright and happy — u as cheerful 
as ever " —although having daily the most 
depleting haemorrhages. Phosphorus has de- 
pression and irritability, but it also has joyful- 
ness, serenity, ready flow of (pleasing) ideas, 
thoughtfulness, vivacity and impetuosity. In 
lung disorders how often do we see mental and 
cesses for which phosphorous is the efficient 
spiritual elevation associated with morbid pro- 
remedy. 

Next to phosphorus, crotalus did seem well 
indicated, but we opine a grave mistake was 
made in changing from the former ; perhaps a 



SYMPTOMS. 51 

change of potency was required to develop more 
fully the power of the remedy that had done 
good. But if crotalus was a proper choice, 
wherefore ledum ? We are afraid our doctor 
was just about an inch or two off his base. For 
now followed in quick succession viburnum, 
cinnamon, erigeron, aconite, bryonia, also at 
short intervals thereafter, rhus, baptisia, ar- 
senic, hydrastis, coco, then a return to erigeron, 
ergot, tincture of iron, ipecac, and then — anew 
doctor. The angel Gabriel couldn't have saved 
the case now, not to say anything about an 
Iowa Falls Angell. We can sympathize with 
and appreciate the doctor in his floundering 
about, for we have done considerable floundering 
about ourselves, with perhaps less excuse for 
our blundering ; but there is one hard-headed 
fact which experience has taught us, that in 
desperate cases unless we have the intuition to 
seize upon the pivotal symptom and apply the 
right remedy first^odi help the patient, for the 
doctor won 1 1 ! 

YAEIETIES. 

The differences existing between cases of 
purpura are due to individual idiocy ncrasy, 



52 PURPURA. 

and to complicating influences. For purposes 
of study cases are assorted into varieties, the 
principal of which are simplex, hemorrhagica, 
and rheumatica, but these have merely a 
clinical import, just as we speak of mild and 
malignant types of scarlet fever, measles, or 
other exanthemata.* 

Purpura Simplex. — The mildest form of this 
disorder is that seen in persons past the 
middle term of life, whence it is sometimes 
called purpura senilis. It appears principally 
upon the thighs, legs, and forearm, in the form 
of small, round, bright-red spots. These are 
due to degeneration of the tissues, and may 
occur spontaneously, or as the result of 
pressure, undue exertion, or any influence 
which throws an unusual stress upon any 
portion of the cutaneous capillary system. 
Where it occurs spontaneously, the spots are 
rarely of any considerable size, and generally 
come in crops, a new set appearing as the 
former fades. When it develops in the 
predisposed from slight traumatism, the 
blotches are irregular in form and of larger size. 
Bateman relates a case in which theie was no 



VARIETIES. 53 

constitutional disturbance, but in which " a 
constant series of these ecchymoses had 
appeared for a space of ten years. 3 ' In most of 
these patients the purpura is modified, and in 
some cases entirely vanishes, whenever the 
patient maintains for a few days, a recumbent 
position ; and indeed in all cases recumbency 
is advantageous, and in severe ones essential to 
a cure. This would seem to indicate that 
cardiac debility has something to do with this 
disorder, as a predisposing influence, as 
suggested by Buhl. 

In individuals of more robust constitution the 
ecchymoses may be preceded for a few days by 
lassitude, pain in the head and aching of the 
limbs ; but these concomitants are by no means 
constant factors. Where the only symptom 
noted is the mottling of the skin, this can be 
proven to be extra-vascular, and therefore 
hsemorrhagic, by the fact that it does not 
change color under pressure. Each spot, after 
remaining livid for about a week, gradually 
changes to bluish, greenish, and saffron tint, 
grows indistinct, and in another week is gone ; 
this opalescence is due to the slow 



54 P U ?v P U R A . 

metamorphosis of the hsematin retained within 
the interspaces of the cutaneous structure. 

Purpura IlamorrJiagica. — The hemorrha- 
gic variety— called also Morbus Maculosus 
Werlhofii — is more likely to be preceded by 
I)remonitory symptoms than the one already 
discussed. These may come in the form of per- 
sistent or frequently recurring hemorrhages, 
such as nose-bleed, or bleeding from the gums ; 
or as bone-pains ; or as a subtle but pervasive 
langour. So far as the skin is concerned the 
manifestations of the disorder do not differ 
from those observed in the simple variety, save 
that they are more severe. The term hemorr- 
hagica is only applied when bleeding is a prom- 
inent factor in the case. This maybe from the 
skin itself, or from any of the mucous surfaces. 
The most common form is nose-bleed. The 
amount of blood-loss at any one time may be 
inconsiderable, but by long continuance the 
system be very much weakened, and vital 
power undermined. Bleeding from the gums 
is a frequent symptom, but not so characteristic 
as in scurvy. If the gums (in the cases where 
these bleed) be examined they will be found to 



V A RIETIES. 55 

be covered with blackish scabs, beneath which 
the mucous membrane is pale and not swollen ; 
in scurvy the gums are swollen and spongy. 
In hemorrhagic purpura patches of extravasa- 
tion will be found upon free mucous surfaces, 
as oh the roof of the mouth, on the inside of 
the cheek, beneath the tongue, or in the 
pharynx ; or these may take the form of blood- 
blisters, which bursting break down in ulcera- 
tion. Hsematemasis is a much less frequent 
form of bleeding, though when it does occur is 
apt to be profuse and exhausting ; the diges- 
tion of aliment is interfered with, or altogether 
prevented, by the irritated state of the gastric 
mucous membrane. Bleeding from the bowels 
(melaena) is still more rare, and is not especial- 
ly significant except when associated with 
copious haemorrhage from other parts. Hema- 
turia is a very frequent complication, and is 
probably met with in more cases occurring in 
males than any other single hemorrhage save 
epistaxis. The blood may come from the 
bladder, the ureters, or the pelvis of the kid- 
ney ; generally the latter. Menorrhagia and 
metorrhagia are more common in women than 



56 PU R P IT E A . 

hematuria. Haemorrhage into the conjunctiva 
is not uncommon. Bleeding from the ears oc- 
curs occasionally. Haemoptysis is rare. Blood 
is sometimes extravasated into the muscular 
tissue, into the parenchyma of the viscera, and 
death has occurred from cerebral and pulmon- 
ary apoplexia. 

At the beginning of the attack there is 
usually no fever, but if the disorder continues, 
and the patient is weakened by blood-loss, hec- 
tic is apt to supervene. The bodily tempera- 
ture may be normal in the morning, but rises 
in the evening to the neighborhood of 100 q 
Fahr. The pulse is usually weak, but quick- 
ened beyond the normal rate ; it may be inter- 
mittent ; in some cases arterial tension is sub- 
normal, with slowness in the rate. There is 
usually depression, both moral and physical, 
lie feels low-spirited and melancholic, with 
great lassitude and debility. Fainting or even 
syncope are not uncommon. As the disease 
progresses, anaemia becomes more and more 
manifest. The countenance becomes blanched ; 
the mucous membranes grow pale and blood- 
less ; the breathing, asthmatic and difficult ; 



VARIETIES. 57 

the extremities, oedamatous ; there is a venous 
hum in the neck, tinnitus annum, and every 
sign of approaching dissolution. 

If the prima via is not invaded by the ecchy- 
moses, the digestive functions may remain 
quite unaffected. In other cases there is 
nausea and vomiting, epigastric pain and 
diarrhoea. Congestion in the various viscera 
may cause pains in the abdomen, chest, or 
back. Bright's disease is sometimes consecu- 
tive to purpura, although in some cases albu- 
minuria precedes the development of the cu 
taneous phenomena. 

Par pur a Rheumatica. — Many cases, espec- 
ially in children, are preceded or accompanied 
by pains in the joints, which simulate rheuma- 
tism ; these are also called pelosis rheumatica. 
Such a case usually begins with severe pain in 
a joint, with or without effusion. This lasts 
for several days, when numerous petechial 
spots appear about the affected joint, while the 
other parts of the body are entirely free, or pre- 
sent but a few isolated patches. The ecchymosed 
spots are slightly elevated, from the diffusion 
of coagulated fibrin, and are surrounded by a 



58 P U R P IT R A . 

delicate halo. Not only the joints are swollen 
and painful, but also the long bones, the dor- 
sum of the hands and the sole of the feet are 
tender on pressure, so that the use of the extremi- 
ties, and especially walking, is painful and 
difficult. In many cases the pains alternate 
with the purpuric appearances ; as one grows 
more pronounced the other disappears, and 
this alternating of symptoms may go on for 
weeks or months. Albuminuria is often pres- 
ent, but not always. Occasionally the pur- 
puric patches, which in the so-called rheumatic 
variety are almost invariably round, are asso- 
ciated with vesicles containing bloody fluid, or 
with wheal like efflorescences resembling ery- 
thema nodosum. That these cases are not pri- 
marily rheumatic is demonstrable. The occur- 
rence of the joint-pains may be due to the 
presence of purpuric extravasations in the syn- 
ovial membranes, analogous to those which 
have been found in serous tissues elsewhere. 
Some of these cases assume an annual type, 
recurring each year at the same season. 

Henoch has observed a peculiar form of this 
variety of purpura, in which vomiting, intesti- 



VARIETIES. 59 

nal haemorrhage, and colic, are also present. 
Here are three of his cases : 

1. A. boy, aged fifteen ; gastro- duodenal 
catarrh, with slight jaundice in consequence of 
indigestion. A few days later, pains in the 
joints of the fingers ; a few days afterwards, 
purpura upon the thighs, with colic, vomiting, 
and black stools. At times the colic was ex- 
tremely severe ; region of transverse colon ten- 
der and distended. Moderate fever. Disap- 
pearance of the symptoms in five days, but a 
relapse at the end of three days ; convalescence 
in a week. Three relapses in the next few 
weeks, always attended with bloody stools. 
Finally, complete recovery. 

2. A boy, aged four ; suffering from colic, 
tenesmus, and scanty, bloody stools. At the 
same time large patches of purpura on the 
elbows and thighs. Improvement in three 
days, but new patches on scrotum and pre- 
puce. A few days later another attack of 
diarrhoea, with streaks of blood and severe 
colic, then constipation and fresh exacerbation 
of purpura. Entire duration three weeks. 

3. A healthy girl, aged twelve ; for a week 



60 PURPURA. 

rheumatic pains in the limbs, followed by ten- 
derness and swelling of the wrist and ankle- 
joints, with slight fever : heart intact. A few 
days later purpura on the abdomen and lower 
extremities ; very severe colic, repeated vomit- 
ing, and bloody diarrhoea. Disappearance of 
the symptoms in five days. Four relapses 
within a month ; finally, complete recovery. 

Purpura sometimes supervenes on other skin 
affections, whence arise the types which are 
called pur par a urticans, purpura papulosa, 
and so on. 

Ollivier mentions a somewhat anomalous 
type in which large ecchymoses appeared in 
successive crops, associated with general oedema 
and severe enteritis. 

The Irish purpuric disease described by Lin- 
gen, in the British Medical Journal, 1867, ap- 
pears to have been a contagious disorder, and 
consequently not allied to the one here con- 
sidered. 

DIAGNOSIS. 

The diagnosis of purpura is comparatively 
easy, although there are several disorders with 
which it might be confounded. It may be dis- 



DIAGNOSIS. 61 

tinguished from the /uejiorrhagic diathesisbj 
the fact, that in this latter the blood escapes 
from a contusion, wound or ulcer, and is nota- 
ble for the profusion of the loss without visible 
adequate cause ; while in purpura the tendency 
is toward numerous spots of extravasation on 
all parts of the cutaneous and mucous surfaces. 
The hemorrhagic diathesis is usually an here- 
ditary tendency and shows itself in early life ; 
on the other hand, purpura is never a family 
trait, and is peculiarly a disorder of the mid- 
dle-aged and senile. 

Purpura is more likely to be mistaken for 
scurvy, but in this latter disorder the gums are 
spongy and sore, the joints stiffened, the limbs 
swollen and painful, and the complexion pale 
and sallow ; while in purpura very often there 
is an abscence of any obvious signs of ill- 
health. Scurvy is always caused by a lack of 
fresh vegetables in the daily allowance of food, 
and is not likely to occur singly ; neither of 
these propositions are true of purpura. A fresh 
vegetable diet at once begins an improvement 
iu the scorbutic patient and prevents the ap- 
pearance of new hemorrhagic spots, but diet 
has 'no suchjrindly influence over purpura. 



62 P U R P U R A . 

Purpura can be easily differentiated from 
hemorrhagic measles by the coryza and bron- 
chitis of the latter ; from ty pitas by the history 
of the case, the cerebral complications, and the 
insignificant size of the spots and their even 
distribution over the body ; from the ecchy- 
moses of traumatism by the local character 
and larger size of the spot in the latter ; from 
flea-bites, which in unhealthy persons often 
maintain their petechial character even for 
weeks, from their uniformity of size and ap- 
pearance, and the presence of the minute point 
of puncture in the center of the petechia ; and 
from non-luemorrhagic eruptions by not 
fading under pressure. 

PROGNOSIS. 

Purpura is a malignant disorder. Mild cases 
usually recover, but relapses are frequent, and 
when associated with haemorrhage^ generally 
fatal ; death occurring from the consecutive 
haemorrhage, or from the debility resulting 
therefrom ; or, occasionally, from pulmonary 
or cerebral apoplexia. The extravasated blood, 
when not quickly absorbed, acts upon the tissues 
as an irritant, excites inflammation, or leads on 



TREATMENT. 63 

to gangrene. Death may result either from the 
debility thus induced, or from #py rem ia. 

TREATMENT. 

The general rules governing the selection of 
the appropriate remedy apply in purpura as in 
all other disorders of the human economy. 
Although I have endeavored to bring together, 
for easy comparison, all those drugs which are 
known to possess relationship to ecchymoses, 
'it is quite possible that in any given case the 
practitioner will need to go outside of even this 
rather formidable list for the remedy homoeo- 
pathic to the case. There is, of course, no such 
thing as a remedy for purpura. It is obvious that 
what will speedily cure one case will have no in- 
fluence over another; and that here, as elsewhere, 
success can only come through the careful col- 
lating of all the symptoms of the case, and ap- 
plying thereto the remedy selected according 
to the method of Hahnemann, wdiatever it may 
be, or how far it may carry us outside of pre- 
conceived notions of the appropriate. 

In treating these cases due regard must be 
had ta the circumstances of the patient ante- 



64 PTT'KPIJRA. 

cedent to the attack. IT the diet has been un- 
suitable, or deficient in any nutritive element, 
this must be corrected. While the proper 
amount and quality of the food to be ad 
ministered to the patient can only be deter- 
mined after all the factors of the case are known, 
a well-regulated diet, as a rule, is made up of 
a due proportion of animal and vegetable food, 
to which may be added at dinner a glass of 
sound claret, tokay, or Speer 1 sport, according 
to the taste of the patient, or the judgment of 
the physician ; but it must not be overlooked 
that in some cases, even a small quantity of 
alcohol does harm. Where the debility is very 
great, a milk diet may be the most advanta- 
geous. For many cases, this may be improved 
by adding a level spoonful of Beef Peptonoids 
to each goblet of milk. A preparation has 
recently been put upon the market, a dry pow- 
der extract of malt, which combines nicely with 
milk, soups, and liquid foods in general, and 
adds to their palatableness and nutritive quali- 
ties. The aim must be to more than make up, 
by easily assimilated foods, for the blood loss, 
in order that the patient may re-act from the 
debilitating tendencies of the complaint. 



TREATMENT. 65 

Rest is another important factor in the treat- 
ment of these cases ; so much so, that even in 
simple purpura it will be sometimes impossible 
to effect a cure unless the patient maintain a 
recumbent position. A case may apparently 
completely recover, but as soon as the patient 
goes about again the spots immediately return. 
This is a frequent cause of relapse. 

Local measures are not often required, even 
when the haemorrhage is severe. The appro- 
priate remedy will control this, and all other 
untoward symptoms. Still where there is 
great loss of blood, pressure, the tampon, or 
cold applications may be resorted to as tem- 
porary expedients. When the ecchymoses are 
principally upon the extremities, careful band- 
aging of the limb may be found useful. 

Ther3 is one very important point in the 
treatment of purpura which cannot be too 
strongly enforced — the prevention of bruising 
or any form of traumatism. Even in the sim- 
plest cases the greatest care is desirable to 
prevent abrasion of the skin or mucous sur- 
faces, or rupture of superficial blood-vessels, 
or the hemorrhagic character of the disease 



66 PURPURA. 

will be made manifest. The venerable Dr. A. 
E. Small, of Chicago, has related to me the 
following cases, which should serve as a warn- 
ing to every practitioner : 

A child, apparently robust and playful, aged 
ten months, was brought to him by its mother, 
with a request for him to lance its gums, in or- 
der to hasten the process of dentition. He 
observed a few ecchymosed spots upon the lower 
extremities, and declined acceding to the 
mother' s request. She took the child to another 
physician, who applied the lancet. A pro- 
fuse and persistent haemorrhage ensued, and in 
^spite of all that could be done to avert it, the 
child bled to death. In another case which 
came under his observation, a gentleman 
of feeble constitution complained of great de- 
bility and soreness, in spots, about the llesln^ 
portion of the upper and lower extremities. 
On the surface of these sub-cutaneous sore 
spots there was a purplish hue, which looked 
suspicious. He at the same time appeared to 
suffer from a caries tooth, which contrary to 
advice he had extracted. A hemorrhage from 
the gums set in, and with great difficulty it was 



T E E A T M E 1ST T . 67 

arrested, after two or three'weeks styptic treat- 
ment. Feeling convinced that the whole sys- 
tem was suffering from the hemorrhagic dia- 
thesis, it was obvious enough that this condi- 
tion must be changed before the effect would 
cease ; and appropriate medication having 
been administered to this end, the patient fully 
recovered. There had been no previous disease 
that could possibly generate the diathesis ; it 
had sprung up spontaneously. 



THE REMEDIES AND THEIR INDICA- 
TIONS. 

CROTALUS. 

Skin. — Ecchymoses. Purpura hemorrhagica. 
Petechise. 

1. Patches of ecchymoses in the course of 
the small blood-vessels, like the foliage on the 
branches of a tree. The poison had a marked 
effect in producing extravasations of blood. 
[From application of the dilute venom to the 
mesentery of a cat. Brustto^t and Fayrer; 
Proceedings Royal Society, vol. xxiii. page 
270, 1875], 

2. After nine days the fever abated, and he 
began to mend ; but his hand and arm was 
spotted like a snake, and continued so all sum- 
mer. In the autumn his arm swelled, gathered, 
and burst ; and then away went the poison, 
spots and all. [After a bite on the hand in 
February. J. Briejntal ; Lond. Philosophi- 
cal Transactions, vol. ix, page 229]. 

3. The child soon after being bitten became 
disfigured by yellow and dark-colored spots on 
the skin. These symptoms disappeared in the 



70 CRO TALUS. 

winter ; but at the return of the same period 
of the year they reappeared ; the hands and 
feet swelled, and the child died. [Constat- 
tine Hering ; Symptom 3312]. 

4. Annually after the bite, at the same time 
of the year, the pains, swelling and fever re - 
turned, with blue and yellow spots on the 
body. [Schcepf, quoted by C. Heking; Symp- 
tom 3313]. 

5. Face discolored ; blood issued from nose, 
eyes, and ears, and from stomach in the vomit. 
[Spix, quoted by C. Hering ; Symptom 2656]. 

6. Thirty-six hours after a bite on the leg the 
whole side up to the arm became black with 
the effused blood, so much so that those who 
saw him observed that he looked like the 
snake that had bitten him. [A. Gr. Miller ; 
Boston Medical and Surgical Journal, 1833, 
vol. viii, page 240]. 

7. A good deal of subcutaneous, submuscu- 
lar, and intermuscular sanguineous extravasa- 
tion, of a dark-purple color, in neighborhood of 
bite. [Post-mortem, shortly after death from 
bite on back of neck. Sieveking ; Medical 
Times and Gazette, vol. v, page 130]. 

Concomitants. — Purpura, especially on the 
lower extremities, and in debilitated states of 
the system, and in broken-down constitutions, 
such as exists in chronic alcoholism. 



CONGO 31 IT ANT SYMPTOMS. 71 

General soreness. 

Easily tired by slight exertion. 

Tremulous weakness, as from impending 
evil. 

Faintness. 

Drowsy, but cannot sleep ; generally feels 
worse after sleep. 

Sadness and melancholy. 

The pulse is sluggish, feeble, thread-like, 
w r eak, wavy, trembling, and scarcely percepti- 
ble. 

Debility of the heart. 

A feeling as if the heart tumbled over. 

Bleeding from the anus and the other open- 
ings of the body. 

Coldness and insensibility of the skin. 

Skin usually dry and cold. 

Skin like thin parchment. 

Skin, except where discolored, of a leaden, 
pallid appearance. 

Oozing of blood from the pores of the skin. 

Relationships. — The action of crotalus is 
very similar to lachesis, naja, elaps, and 
other venoms, and the distinctions between 
them are mainly relative. Dr. Fayrer draws 
the following comparison* : " In all cases where 

*On the Nature and Physiological Action of Crotalus 
venom, as compared with that of Naja Tripudians and 
other Indian venomous snakes. 



72 CROTALUS. 

the blood forms a firm coagulum after death, 
the poison is of a coluber ; and in all cases 
where it remains perfectly fluid it is of a viper. 
We may take the naja tripudians as heading 
the scale of those poisons whose action upon 
the blood produces a coagulum, and the crota- 
lus as the synonym for the opposite class, 
whose action on the blood produces permanent 
fluidity. It is probable that the action of all 
the snake poisons ranges between those two ex- 
tremes." 

Naja has more nervous phenomena, and cro- 
talus more tendency to slough than any of the 
other venoms. Lachesis has a cold and clam- 
my skin, while that of crotalus is cold and 
dry. Those who survive the bite of the crota- 
lus suffer more permanently than from any 
other snake-poison. The chronic effects of 
crotalus are more apt to develop on the right 
side of the body, and those of lachesis on the 
left. Crotalus acts more intensely on stout 
people than on lean, and on white persons than 
on negroes. 

Comments. — The crotalus hemorrhage is 
evidently due to disorganization of the blood, 
and is not a mere topical effect. The discolora- 
tion produced by this haemorrhage varies from 
black through all the shades of greenish, blue- 
ish, yellow and mottled, the same as is seen in 



COMMENTS. 73 

the successive stages of purpura. After death, 
in chronic cases of poisoning, tissues and 
structures at a considerable distance from the 
original wound are frequently found thorough- 
ly infiltrated with decomposed blood, and in a 
state of gangrene. 

The blood is fluid, dark in color, and not co- 
aguable, and appears to leak through the vas- 
cular walls and escape into the surrounding 
tissues, or effuse from the surface of the 
mucous membranes, or into the serous sacs en- 
closed by the pleura, pericardium, or perito- 
neum, as if the blood-vessels had no power to 
retain within them the circulating fluid ; as 
if the entire system was in a state of dissolu- 
tion. The liver is enlarged and lardaceous ; 
the kidneys are granular ; and in fact the 
whole organization is permeated with the 
effects of the venom. 

In purpuric cases of the zymotic diseases 
crotalus is perhaps the most generally and the 
most frequently indicated remedy yet discov- 
ered (Haywaed). 

Clinical, — The following cases are reported 
by Pr. J. W. Hay ward, of Liverpool, Eng.: 

1. Mr. L., aged 62, a bachelor, of rather ir- 
regular habits, especially as to alcohol, and 
living in a very isolated way with an old 
mother ; after having been in a weak and low 



74 CROTALUS. 

condition for some time, noticed small purple 
spots appearing on his legs ; and very soon both 
legs, from the knees to the ankles, became cov- 
ered with ecchymoses ; there was also some 
bleeding with his stools, and his general circu- 
lation was very languid. Crotalus 6 was or- 
dered four times a day, and some out-of-door 
exercise. All the ecchymoses had disappeared, 
his stools were free from blood, and he was in 
a much better state of health within four 
weeks. 

2. Mr. B., aged 48, who had lived freely in 
youth and had syphilis. From 24 years of age 
to 35 he suffered on and off with hematemesis 
and mel^ena, followed by general debility and 
weak heart with chronic rheumatism, head- 
ache, constipation, attacks of vertigo, jaundice, 
etc., and when about 44 he became invalided, 
and suffered much with dizziness, fainting 
and irregular action of the heart ; and pete- 
chia now broke out over the whole body, 
especially the lower extremities. Several rem- 
edies were used, but he benfitted most under 
mercury, kali, phosphorus, and crotalus. It 
was whilst taking crotalus 6 that his petechia 
disappeared, and he made most progress. He 
made a good recovery ; and is now, at 52, in 
fairly good health. 

The following cases were furnished to me by 
Dr. W. J. Clary, of Chicago : 



C L O I C A L CASES. 75 

3. This patient was a young lady aet. 19 
years, of consumptive habit. This case had 
red spots in the eyes, some in the mouth, a few 
on the chest, arms and hands. She spat small 
clots from the mouth, frequencly. Having 
never seen a case of the kind I did not f ully 
comprehend the condition. Two days later I 
was called in haste to see her on account of a 
severe haemorrhage from the bowels. The dis- 
charge of blood had increased in the mouth, 
also the number of spots on the surface of the 
body. When I arrived she had passed about 
six quarts of fluid from the bowels, consisting 
of bloody water and soft broken clots. I gave 
crotalus, as it seemed to be the only remedy 
indicated by the symptom : Haemorrhage from 
every orifice of the body. I gave the 6th dilu- 
tion in water, a dose every two hours. 

The next .day the symptoms were so much 
improved that but little doubt of recovery re- 
mained. The haemorrhage from the bowels 
had ceased, less blood in the mouth, spots 
were fading. Improvement continued steadily 
until the eighth day the patient was discharged. 

There was no return of the symptoms. 
Shortly afterwards the patient passed out of 
. my hands to be treated by a person who 
promised to surely cure her of consump- 
tion. She died in about six months. A 



76 CEOTALUS. 

friend of the family remarked to me about the 
time of the treatment of the young lady for 
purpura that she acted just like two cases he 
had seen die from rattlesnake bite. 

4. The second case was a girl aged 11 years, 
who appeared as though she had been severely 
bruised on various parts of the body, especially 
on the face, arms and chest. Some of suggil- 
lations were as large as the palm of my hand. 
There was some swelling where the suggilla- 
tions appeared. No red spots appeared. I 
gave cro talus 6 every four hours. All ap- 
pearance of the disease vanished in ten days. 

5. The third case, a girl set. 7. was taken sick, 
and as nothing serious was apprehended no 
physician was called until haemorrhage oc- 
curred from the bowels. I found the patient 
pale and weak, with slight fever. The charac- 
teristic red spots appeared, mostly on the upper 
part of the body. I gave . crotalus 6 about 
one week. The patient appeared to be fully re- 
covered and was discharged. A few days after 
I w T as called again, as the disease had returned. 
I found her with violent fever, unconscious and 
very restless, pulse frequent and tense. I gave 
arsenicum. The patient died in less than two 
hours in a spasm. 

6. The fourth case was a girl aged 13, who 



CLIJSTICAL CASES. 77 

was attacked suddenly with violent fever and 
pain in the head. I gave aconite and bella- 
donna, and ordered bathing and cool applica- 
tions to the head to allay the great heat from 
the fever. During the night, near morning, 
she had profuse haemorrhage from the bowels. 
For this condition an allopathic physician was 
called. He told the parents that there was no 
chance for the patient to recover. I gave a fa- 
vorable prognosis and treated the case. I gave 
crotalus 6 a dose every U\o hours, with orders 
to lengthen the intervals if she improved. After 
a few hours the haemorrhage ceased, to return 
no more. Improvement was rapid, and in a 
few days I discharged the patient. The spots 
in the eyes and mouth, and on the face, arms 
and chest, were present at my second visit 
or immediately on the occurrence of the 
haemorrhage. 

PHOSPHORUS. 

Skin. — Ecchymoses. Petechia. Gangrenous 
patches. 

1. Red patches upon the arms. Insensibility 
of the skin of the extremities. Ecchymoses 
on the costal pleura. Ecchymoses on the peri- 
toneum with bloody serum in its cavity. The 
spleen enlarged, softened, and with ecchy- 
moses under its serous coat. Ecchymoses on 



78 PHOSPHORUS. 

the mucous membrane of the bladder. Sub 
peritoneal ecchymoses on the uterus and its 
appendages, and also between the laminae of 
the mesenterjr. [Post-mortem on Maria Le- 
blanc, who on the evening of June 5, 1856, six 
hours after eating, swallowed the combustible 
matter of a box of matches dissolved in a cup 
of coffee. Died on 15th inst. Prof. Leudet. 
Archives Generate de Medicin, March, 1857, 
This case, says W. H. Holcombe, M. D., 
North American Journal of Homceopathy, 
vol. vii, page 140, remarkably illustrates the 
power of phosphorus to produce those blood- 
metamorphoses or those modifications of the ca- 
pillary system, perhaps both at once, which 
result in haemorrhages, either by ecchymoses 
into the tissues, or by exudations into the cavi- 
ties. Orfila, in his treatise on Toxicology, says 
that the petechial eruptions of phosphorus are 
red, while those of arsenic are black or blue]. 

2. The skin was yellow ; the subcutaneous 
veins of the abdomen and the upper part of 
the thighs were protuberant and arborescent ; 
the scrotum was completely covered with 
ecchymoses. About the cardiac and pyloric 
orifices there were black, or rather marbled, 
spots, which were genuine ecchymoses. [Poi- 
soning by ten centigrammes of phosphorus, 
dissolved in hot water. Died six days subse- 



PATHOGEKESY. 79 

quently. Orfila ; Treatise on Toxicology. 
Report of Dr. Woebe]. 

3. The cutaneous surface exhibited numer- 
ous patches of livid discoloration. There were 
numerous extravasations on the pleura, mesen- 
tery, and other tissues. [Grirl of 13, who took 
an unknown quantity of phosphorus paste. 
British Journal of Homoeopathy. Vol. xxi, 
page 460]. 

4. The lungs showed many patches of blood 
extravasation ; the sub-pleural cellular tissue 
had numerous ecchymoses, and the cellular 
tissue of the mediastinum presented the same 
appearances ; in the pleura was bloody serum ; 
the sub-peritoneal cellular tissue presented 
patches of ecchymoses ; the mucous membrane 
of the pelvis of the kidney was covered with 
spots of ecchymoses. [Soldier, aged 21, who 
in order to commit suicide took the ends of six 
ordinary packets of phosphorus matches. 
American Journal of Medical Sciences , Jan- 
uary, 1858.] 

5. Very large ecchymoses of extravasated 
blood under the serous membrane of the lungs, 
both costal and visceral ; the lungs presented 
here and there small ecchymoses ; the pericar- 
dium and endocardium also exhibited ecchy- 
mosed spots ; and there were small ecchymoses 



80 PHOSPHORUS. 

in the substance of the liver. [A case of sui- 
cide accomplished by swallowing the inflam- 
mable material of four boxes of lucifer- 
matches, scraped off into a wine-glass full of 
brandy. Prof. Leitdet ; Archives Generate de 
Medicin, March, 1857]. 

6. The mucous membrane of the larynx and 
trachea were covered with patches of ecchy- 
moses, as was also the pleura ; beneath the cap- 
sule of Glisson there were numerous spots like 
petechia, and extravasations under the an- 
terior surface of the capsule of the kidney. 
[Augustus K., aged 30, March 14, 1865, put the 
ends of eight packs of phosphorus matches into 
a glass of hot water, let them lie a quarter of an 
hour, and drank about three-quarters of the so- 
lution. Dr. Vo^Pastatt, Breslau. Virchow's 
Archives, xxxiv, 3]. 

7. Erythematous and hemorrhagic patches 
occur in the skin with a gOod deal of irritation 
and hyperesthesia ; this hemorrhagic infiltra- 
tion of the skin is accompanied by similar 
patches in the serous membranes and other 
tissues : ecchymoses and gangrenous spots are 
found in the intestinal tract. [Constitutional 
effects of poisonous doses of phosphorus. 
Chas. D. F. Phillips, Materia Medica and 
Therapeutics. Vol. I, pages 38 and 41]. 



PATHOGEIESY. 81 

8. The eccliymoses occur in all parts of the 
body, but are apt to be especially pronounced 
in the mediastinum and the serous membranes. 
[H. C. Wood, Treatise on Therapeutics, 1883,. 
page 112]. 

9. It has been found that in dogs, after death 
from phosphorus, the blood does not pass into 
the veins, but remains in the arteries ; showing 
that the capillaries are occluded, impervious, 
or disorganized. [Prof. Schiff, Archives fur 
Exper. Path, und Ther. Bd. I, page 347]. 

10. About thirty little red specks not quite 
as large as the head of a pin, upon the anterior 
part of the back of the left hand and upon the 
fingers of the same hand, especially the third 
and fourth, as if the blood had settled under 
the skin, without sensation, coming out at 10 
A. M., and lasting all day. [Observation of 
Dr. B. FrsrcKE, from a dose of phosphorus, 
80 m.] 

Concomitants. — Sadness recurring regularly 
at twilight. 

Great timidity associated with a sense of ex- 
treme fatigue. 

Oversensitive ro external impressions : light, 
odors, noises, contact. 

Aversion to coition, or irresistible desire. 

Difficulty of falling asleep ; followed by 
frightful dreams. 



82 PHOSPHORUS. 

Sensation of weakness and emptiness in the 
abdomen. 

Great longing for acids and spicy things. 

Constipation ; the foeces being slender, long, 
narrow, dry, tough, and hard like a dog's; 
voided with great difficulty. 

Hemorrhoids, burn like fire and bleed pro- 
fusely. 

Glycosuria. 

Albuminuria. 

Palpitation of the heart, even while sitting. 

Remarkable paleness of the skin and mucous 
membranes. 

Lips and eyelids cedematous. 

Nose-bleed and other haemorrhages. 

Slight wounds bleed easily. 

Ataxic symptoms with cardiac and respira- 
tory derangements. 

Aggravations. — Changes in the weather and 
emotional excitement are apt to have a de- 
pressing influence on the phosphorus patient. 

Relationships. — Phosphorus is best suited 
to elderly persons, rather than to children, 
unless these have grown rapidly ; to fair com- 
plexioned persons of sensitive disposition and 
quick perceptions. 

Comments. — Phosphorus may be useful in 
purpura hemorrhagica caused by blood- 



COMMENTS. 83 

changes or by fatty degeneration. In a case 
of phosphorus poisoning observed by Fried- 
richs an exanthema of an exquisitely hemorr- 
hagic character, on the lower extremities, was 
associated with an unmistakable change in the 
character of the blood-disks. Very few of 
these were normal in form or size. Many of 
them were oblong and were compressed as from 
ligatures ; this process continuing until they 
were actually divided into two uneven parts, 
and this went on until, finally, blood-disks of 
very minute diameter were formed. This de- 
composition of the blood was very evident, 
even on the most cursory examination, as it 
became very dark in color and lost all power of 
coagulation. 

Phosphorus sets up an acute fatty degenera. 
tion in every part of the body, and this causes 
a suspension of the functions of the liver and 
kidneys. Some similar change is present in 
the capillaries in cases of purpura. In that 
recorded by Dr. William Fox in the British 
and Foreign Medical and Chlrurglcal Re- 
ritw, October, I860, he states that u sections of 
the skin near, but not in the parts affected with 
hemorrhagic extravasations, gave either with 
Schnitzels solution (chloride of zinc and 
iodine) or with iodine alone, or iodine and 
sulphuric acid, a most intense reddish-browm, 



84 PHOSPHORUS. 

in portions between the fat, besides corres- 
ponding to the course of the capillaries. This 
colorization did not pass much into the papil- 
lae. The color, with Schultze's reagent was 
somewhat evanescent ; but that with iodine 
lasted from forty-eight to seventy-two hours, 
and in some preparations the marking out of 
the capillaries was beautifully affected in this 
manner. This change was not constantly met 
with in all portions of the skin tested ; but was 
best marked in portions taken in close prox- 
imity to the affected spots. In some of these 
parts, in which I succeeded in isolating por- 
tions of the capillaries and smaller arteries, I 
found that they broke up very easily, that 
some presented a peculiar glistening, waxy 
look, while others had a non-granular appear- 
ance, in no degree corresponding to the ap- 
pearances observed in health." Phosphorus 
produces almost identical changes in the mu- 
cous and serous tissues, and to a less degree in 
the skin, and will prove of especial usefulness 
w T here the internal evidences of the disease, as 
shown by haemorrhages from the nose, gums, 
kidney, or rectum, are more pronounced than 
the extravasations into the cutaneons tissue. 

Clinical. — The following case is reported by 
Dr. C. W. Boyce in the American Homoe- 
opathic Review, for June, 1865, page 566. 



CLINICAL CASES. 85 

1. Gertrude Clark, aged seven, was a perfectly 
liealthy child, who had never been sick since 
she was born until the present disease. About 
March 12, I860, the pillow on which she had 
slept at night would be found, in the morning, 
somewhat stained with blood. After a few 
days she began to spit bloody saliva, and on 
examination, March 17, she was found to have 
small spots of extravasated blood all over the 
body. When she had • the least hurt there 
would immediately follow a large spot in the 
vicinity, which would be quite black from the 
extravasated blood. Any little scratch bled 
profusely and continuously. The accidental 
scratch of a pin would bleed so as to saturate 
cloth after cloth. Little red points appeared 
on the tongue and on the whole buccal cavity, 
and these oozed continuously. Blood settled 
beneath the conjunctiva, and the eyes ap- 
peared entirely " bloodshot." The breath 
became peculiarly offensive. The discharge 
from the mouth of bloody saliva was filled with 
shreds of decomposed and disorganized blood. 
The pulse was regular but quick. The appe- 
tite was good and she slept well. She was 
inclined to play and only became exhausted 
after considerable exertion. She had been en- 
tirely well before, for all that her parents had 
seen, and, but for the blood, they would not 



86 PHOSPHORUS.- 

have at first known that anything was the mat- 
ter. This was the condition on March 17. It 
had been five or six days coming on. The ap- 
pearance was frightful ; even ordinary hand- 
ling would leave the marks of the fingers, as 
though a powerful blow had been struck on 
the child, and these spots were inclined to 
extend indefinitely. A slight knock from a 
doll baby's head near the eye involved the 
whole eye and its surroundings in a black un- 
sightly spot. All the secretions were bloody. 

On investigating the case, several remedies 
presented claims for use, but Hahnemann's 
great characteristic indication for phosphorus, 
"small wounds bleed much," led to the inves- 
tigation of this remedy ; that and the following 
symptoms were found to correspond : 

Small wounds bleed much. 

The gums bleed from small causes. 

Much bleeding from the nose from exertion, 
and especially when straining at stool. 

Blows much blood from the nose. 

Swelled and easily bleeding gums. 

The saliva is bloody mucus. 

Great discharge of blood from rectum at 
stool. 

Expectoration of bloody mucus. 

Extravasation of blood from all the tissues. 

Vicarious haemorrhages. 



CLINICAL CASES. 87 

So many of the symptoms were found in 
phosphorus that it was given in the case 
March 18. Up to this time the hemorrhagic 
condition had grown rapidly worse. So very 
weak had she become that she tottered when 
attempting to walk, and she was obliged to sit 
down. For twenty-four hours after the phos- 
phorus was given there was no change in the 
condition. This dose held the case exactly the 
same. 

March 19. Phosphorus was again given. 
Immediately the disease began to diminish, and 
the blood disappeared as it had appeared. 
Thus two doses of phosphorus 200 cured this 
really dangerous disease. 

The subjoined two cases are from an article 
by Dr. William Arnold, of Heidelberg, in the 
Ho I a. VierteljahrscJirift) Vol. v., page 167. 

2. The son of cooper Q. was attacked with 
purpura in August, 1852, having been ailing for 
several days previously. I had seen him eight 
days before, and found him a lively, strong, 
well-nourished boy of good appearance, with 
no sign of any scrofulous or other diathesis ; 
but whose appearance showed that he was ac- 
customed to spend the greater part of the day 
in the open air. Xo cause could be assigned, 
except that in the warm days previous to his 



88 PHOSPHORUS. 

attack he had been a good part of the time 
playing in the river, and should we wish to 
assign this as the cause, it is strange that none 
of his companions, among whom were several 
weakly ones, were similarly affected. 

When 1 saw the patient for the first time, he 
was in bed, complained of weakness, and was 
covered with reddish spots and stripes, being 
most numerous on parts covered usually by the 
clothes. Face and hands were free. Frequent 
epistaxis, occasionally some bleeding from the 
gums, although no spots could be discovered 
in the mouth. Aside from the feeling of weak- 
ness no symptom of general disease. 

August 21, I ordered phosphorus 2 x ; the 
rooms to be well ventilated, and light digest- 
ible food to be given. 

Aug. 23. Condition decidedly improved. No 
haemorrhage in the last twelve hours, and the 
spots are lighter colored and lessened in 
number. At the same time the boy was out of 
bed, felt less tired, and according to the parents 
the boy was livelier and appetite was returning. 
I repeated the medicine, a spoonful every three 
hours. 

Aug. 26. I found the boy playing in the 
garden, he felt well. No more epistaxis. The 
spots had partially disappeared, the balance 
were paler. No more medication and drugs, 



CLINICAL CASES. 89 

and in five days no trace of the disease could 
be discovered. 

3. On the 4th of February I was called to see 
the daughter of Mrs. C. N., a girl of eight years. 
She is well nourished, and was until now in 
perfect health. Her constitution might be 
called a lymphatic one, with some tendency to 
scrofulosis. JMo cause for her sickness can be 
ascertained, unless you wish to assign as the 
cause the sudden death of her father. How 
much the child was affected by this, is difficult 
to judge, as she is accustomed to sit quietly by 
herself, and is not very demonstrative. The 
mother noted no change in her, until on the 
morning of February 4, a haemorrhage from the 
nose and mouth set in. Upon closer observa- 
tion she noticed a number of spots and stripes 
on the whole body, although the little one 
made no complaint. Upon examination, I 
found not alone spots on the entire body, but 
likewise on tongue and palate. Haemorrhages 
were frequent from the nose and mouth with- 
out any apparent cause, especially when clear- 
ing the throat or coughing, which w r ould occur 
after waking from a short sleep. 

Some blood was lost with the stools, the 
stools having the appearance of being covered 
with a thin layer of blood. In spite of this, no 
disturbance of any organ could be discovered ; 



90 PHOSPHORUS. 

there was no fever nor pain ; the child only felt 
somewhat weakened from the loss of blood. I 
prescribed phosphorus 2 x. 

Feb. 6. I called upon the patient and ascer- 
tained that after the third dose the haemor- 
rhages from nose and mouth had ceased, that 
upon awakening she had coughed up no more 
blood. On examination I found the spots on 
body and mouth lessened in intensity. 

The same medicine was ordered, every three 
hours one-half tablespoonful, and on the 9th of 
February, I was happy in being able to dis- 
charge the patient, as far as taking medicine 
was concerned. No trace of haemorrhage for 
several days. The spots had either entirely 
disappeared, or left slight red or yellow-red 
color of the skin. These disappeared without 
any medication, so that fourteen days later, 
when I again visited the child, no trace of spots 
or of any appearance of sickness could be dis- 
covered. 

The following cases were furnished to me by 
Prof. Temple S. Hoyne, M. D., of Chicago : 

4. The patient was a boy about sixteen years 
old, and comparatively healthy. He was very 
fond of meat, but disliked vegetables and would 
hardly ever touch them. There were extravas- 
ations of blood beneath the skin of the arm, 
chest, and other portions of the body. The 



CLINICAL CASES. 92 

slightest breaking of the skin was followed by 
profuse bleeding, and the drawing of a tooth 
caused an excessive and prolonged haemorrhage. 
Lemons and other fruits were ordered in 
connection with phosphorus 200, and the boy 
recovered completely. 

5. A case of purpura, which I saw in con- 
sultation with Dr. Ballard, of this city, was 
accompanied by profuse hemorrhage, which, 
after finally being controlled by plugging the 
nostrils, was followed by an alarming bleeding 
from the lungs and stomach. Even touching 
the lips would bring on haemorrhage from the 
mouth. Phosphorus 200 stopped these haemor- 
rhages, and really saved the girl's life. 

Dr. Elias C. Price, of Baltimore, sends me 
the following observations : 

6. I have seen numerous cases of another 
variety, on the legs of old persons. These 
spots look like real blood blisters, of a very 
bright-red color. The smaller ones are perfectly 
round. They vary in size from that of a No 
30 pellet to two inches in diameter. Phosphorus 
has generally cured this condition in a very 
short time. 

Dr. J. Comp ton Burnett, of London, published 
the two following cases in the Homoeopathic 
World, February, 1873 : 



92 PHOSPHORUS. 

7. About a month since a boy of ten was 
brought to me for treatment. His mother 
stated that on the day previous, there had been 
a rather profuse discharge of blood from his 
nose and mouth. The conjunctiva of the right 
eye was suffused with extravasated blood, and 
the whole neighborhood of the right eye was 
ecchymosed. There were likewise ecchymoses 
on the nose, cheeks and forehead. In fact, it 
looked as if my patient had made considerable 
practical experience of a pugilistic kind. This 
he, however, stoutly denied, and no history of 
an accident could be made out. There were no 
purpuric spots to be detected. Inclining to the 
view that it was traumatic, I prescribed arnica 
mountana. At the second consultation, a week 
subsequently, the mother stated that the boy 
had again had haemorrhages from the mouth 
and nose ; the objective symptoms were the 
same as at the former visit. I now prescribed 
phosphorus 1. Since then there have been no 
further haemorrhages, and the ecchymoses have 
disappeared. 

8. About five weeks since Eliza R., set. seven, 
was brought by her mother, who stated the 
child had repeatedly had bleeding from the 
left ear. On examination I found the whole 
surface of the body dotted with characteristic 
purpuric spots, in size varying from that of the 



CLINICAL CASES. 

scarcely perceptible to that of a four- penny 
piece. There were considerable constitutional 
disturbance and anorexia.The meatus auditorius 
externes of the left side was partially occluded 
with blood clots, which were dry and adherent to 
the walls. Prescribed aconitum and phosphor- 
us in four- hourly alternations. JN T o further 
extravasation took place, and the patient was 
discharged cured a fortnight since. 

9. Dr. Penoyer, of Kenosha, Wis., while 
passing along the street was called in by Dr. 
Farr to see a case of purpura to which he had 
just been called, but for which he had not 
prescribed. After looking over the case Dr. 
Penoyer suggested phosphorus cc. in solution, 
as the case presented a startling resemblance to 
phosphorus toxicosis. At Dr. Farr's request 
he prepared the remedy, which was given as 
directed. The disease disappeared rapidly and 
the patient was discharged convalescent in three 
days. 

LACHESIS. 

Skin. 1. Scarlet-red spots as large as the 
hand on the right chest, shoulder, and arm, 
with great thirst, rapid pulse, short breath, 
coated tongue. [Within twenty-four hours after 
the administration of Lachesis 30 for cancer of 
the right breast. Gross, in Hering's Denies- 



94 LACHESIS. 

thrift der N. Am. Abaci, der Horn. Htilk., 

1837.] 

2. A red burning spot on the thumb. [Effect 
of 30th dilution. Ibid.] 

3. Red spots like bug bites, over the short 
ribs and towards the umbilicus. [Effect of 30th 
dilution ; Wesselhceft. Ibid.] 

4. Sensitive spots as large as a quarter dollar, 
with dark blue-red margins and dry scurf. 
[Effects of 30th dilution ; Hcenig. Ibid.] 

5. Small red points here and there on the 
fingers, which itch very much. [Effects of the 
2d trituration. Ibid.] 

6. After incessant itching there appeared a 
round, red, v;ery hard bunch on the back of 
the middle finger, lasting a long time, without 
vesicles and without suppuration. * * * 
Six weeks later, after a blow on the bunch 
(which had almost entirely disappeared) it bled 
unusually profusely. [Effects of 30th dilution. 
Ibid.] 

7. Various eruptions, burning and itching. 
[Ibid.] 

8. Gangrene. [From a bite. Ibid.] 

9. Trickling of blood from the nose ; in very 
many cases, and in various diseases. [Ibid.] 



COMMENTS. 95 

Concomitants. — Aggravation of all symptoms 
after sleep. 

Loquaciousness. 

Vertigo in the morning on waking. 
Headache extending into the root of the nose. 
Black flickering before the eyes. 
Dryness in the throat, without thirst. 
External throat very sensitive to touch. 
Great physical and mental exhaustion. 
Icy coldness of the feet. 

Comments. — The similarity between lachesis 
and other venoms has been discussed under 
cro talus. The above citations from the provings 
show very little relation to purpura, yet 
lachesis exerts a powerful decomposing influ- 
ence on the blood, and causes gangrene in the 
muscles and viscera. The principle difference 
between lachesis and crotalus is that the 
former has more of the neurotic element (Burt). 
When purpura sets in with an intense prostra- 
tion, which bears down before it alike the 
mental and vital forces, lachesis will probably 
be helpful. The blood is black and not 
coaguable ; the affected parts are bluish, and 
everywhere there is a tendency toward gangrene; 
the patient is exhausted by the constant aching 
pains in the extremities, by the intense febrile 
paroxysms, and by a persistent insomnia, which 
is aggravated by the fact that the patient is 



96 LACHESIS. 

afraid to sleep, as lie feels so much worse 
afterwards. Says Dr. P. Jousset, in the North 
American Journal of Homoeopathy, Vol. ix, 
page 229 : 

" Lachesis corresponds to the more malignant 
form of purpura hemorrhagica. Its patho- 
genesis gives us, haemorrhages and blood- extra- 
vasations in different organs ; ecchymoses ; red 
and black spots on the skin ; epistaxis ; 
haematemesis ; melanosis ; haemoptysis ; great 
lassitude with lipothymia and syncope ; 
considerable prostration ; pulse small, weak ; 
perceptible fever." 

Dr. Richard Hughes, in his Pharmacody- 
namics, Fourth edition (1880), page 604, says 
of the serpent venoms, that lachesis should be 
borne in mind as a remedy : 

1st. Whenever jaundice, primary or second- 
ary, is accompanied with ecchymoses and haem- 
orrhages. Here it compares with phosphorus, 
which would supplant it when the liver was 
intimately affected, as in acute atrophy of that 
organ. 

2d. Whenever the purpuric condition super- 
venes upon other diseases, as typhus or variola, 
constituting their hemorrhagic form, arsenic is 
tolerably homoeopathic, but is hardly rapid 
enough in its action. 



CLINICAL CASES. 97 

3d. When the epidemic cerebrospinal 
menengitis appears in the form known as 
"malignant purpuric" or "spotted fever." 
Here the prostration is long and intense ; the 
febrile reaction slight ; and the appearance of 
petechia constant, with sometimes haemorrhages. 

Clinical. — Prof. Conrad Wesselhoeft reports 
the following case in the British Journal of 
Homoeopathy, 1864, page 491. 

1. Mr. C. H., 22, married, of fair complex- 
ion, light hair, blue eyes, for some time has 
had upon his legs from the knees downward 
purplish or bluish-black circular spots, vary- 
ing from a five cent piece to that of a dime, 
very painful to touch ; at the same time the 
entire portion of the legs pain as if burned. 

His perspiration emitted an odor like that of 
putrescent wine, his breath was likewise very 
offensive ; slept all night but was restless; pros- 
tration after slight exertion and desire to lie 
down were prominent symptoms. Lachesis, 3 
doses cured ; three months after patient feels 
perfectly well. 

Prof. G-. M. Pease, M. D., of the San Francisco 
college, has sent me the following cases : 

2. In 1881, I had a very interesting case of 
purpura to treat, which had been under the treat- 
ment of an Allopathic physician for some time 



98 LACHESIS. 

without relief. The patient was a young lady y 
about twenty-five years of age. She had had 
for some time crops of purpuric spots, varying* 
in size from that of a pin's head to a silver dol- 
lar, coming out very plentifully upon the arms 
and legs, and less freely upon the body. Slight 
pinching at almost any point would bring the 
blood to the surface, and sometimes it would 
ooze through. Merely scratching any uncol- 
ored spot would be speedily followed by an 
extravasation of blood at that point. She had 
a headache every morning, with a sticky, gum- 
my collection in the mouth after a night's 
sleep — that is so much of sleep as she got, for 
she was at frequent intervals awakened in the 
night by churning and itching of the purpuric 
spots, and upon spots at which the extravasa- 
tion was about caking place. Her menses had 
for some time been scanty ; and she was so de- 
bilitated that her strength seemed all gone. 
Lachesis 200 was given at the first visit, and the 
next day there was some evidence of improve- 
ment. On the third day I called again and 
found her so nearly well that I dismissed the 
case, subject to being called if needed. In about 
two weeks thereafter she came to my office and 
stated that there were no fresh spots after the 
second day, and that nearly all the old ones 
had now disappeared, the few remaining were 



CLINICAL CASES. 99 

hardly to be seen. Four years have passed 
and she has had no return of the trouble ; nor 
has she had any other sickness. The Allopath- 
ic doctor who had previously treated her, who 
happened to be a personal friend, was so as- 
tounded that he asked me how it was done. 

3. Another case lately, not so severe as the- 
above, but having many of the same character- 
istics, has also . yielded promptly to lachesis. 
In the cases of purpura which I have had to- 
treat, lachesis has been more frequently indi- 
cated than any other remedy. 

Dr. John L. Seward, of Orange, N. J., pub- 
lished the following case in the American 
Homceopatlust, October, 1885 : 

4. The following case came under my obser- 
vation, soon after I settled in Orange, about 
twelve years ago : 

This patient was a lady, about 40 years of 
age, a school-teacher by profession, and a 
woman of considerable energy. She was a very 
decided brunette, with dark complexion and 
black hair, a heavy frame, but now thin and 
flabby. She had always had very profuse 
menses, even from girlhood, and while she had 
had many doctors she was in no wise benefitted, 
but rather grew worse. Coming into the com- 
munity as a stranger, no one else having helped 



100 LACHESIS. 

her, she determined to try me. When sent for 
I found her flowing very profusely, the blood 
being dark and partially coagulated, and at- 
tended wi'th labor-like pressing from the small 
of the back downward and through the geni- 
tals. The pains were periodical, each being fol- 
lowed by a gush of clotted blood. Her sleep 
was restless, and, indeed, for the most part, 
she was drowsy, but unable to get into any real, 
quiet sleep. She w-as extremely irritable and 
peevish, and presented so strongly the mental 
characteristics of chamomilla, that I gave that 
remedy in the two hundredth potency. This 
seemed to control the haemorrhage, and the 
period lasted for a much shorter time than had 
been her habit. 

Before the time for her next period she went 
on a visit to Syracuse, where she remained 
three months^ and had several severe haemor- 
rhages. On her return to South Orange, I was 
sent for, but the case made very poor progress. 
Again in six weeks she was taken with another 
severe haemorrhage, and became so reduced and 
weak as to thoroughly alarm me. Her mother 
then told me about the purpuric spots with 
which she was affected, and upon examination 
I found a number of splotches of extravasated 
blood upon the chest, abdomen and back, irreg- 
ular in shape, and about half the size of the 



CLIKICAL CASES. 101 

palm of my hand. There were none of these 
spots upon the extremities or neck, they being 
confined both then and at all times, to the 
surface of the trunk. I found, upon inquiry, 
that all her life she would bruise very easily, 
that the slightest knock, or even pressure upon 
the skin, would cause a black and bine mark, 
which would continue to spread until it had 
become quite large, and that ever since she was 
a young lady, these spots had also occurred 
spontaneously upon the body. She had also 
from her youth up been subject to violent nose- 
bleed, and always carried three or four hand- 
kerchiefs at a time, for which she had frequent 
occasion. We had now got along to the mid- 
dle of March, and the weather was quite cold, 
yet she insisted upon having the windows all 
open, and the attendants went about with their 
overcoats and other out-door wraps on ; j^et she 
did not seem to feel the cold. I gave her, at 
various times, arsenic, phosphorus, bryonia, 
and chamomilla, on general principles, without 
apparently accomplishing any good. She had 
become so weak that she could be fed only with 
liquid, peptonized food, and I became so wor- 
ried about her that I fell into the habit of stay- 
ing at the house nights. I noticed one night 
that after she had been in a little doze, that 
she awoke with a suffocative sensation. In- 



102 LACH E SIS. 

stantly there flashed into my mind — Lacliesis ; 
and I then could see many strong resemblances 
between that remedy and this case, which had 
not occurred to me before. I had a little of the 
two hundredth potency with me, and I fixed 
some in water, and began its administration. 
She improved rapidly and steadily from that 
date, and made a complete recovery. The pur- 
puric spots disappeared and never returned ; 
she became less susceptible to bruises than ever 
before in her life ; she had no more epis taxis ; 
her menstruation became almost normal as to 
amount, frequency and painlessness ; and she 
passed through the menopause without trouble. 
This case was among my first successes, and 
wonderfully confirmed me in my belief in the 
homoeopathic law. 

The following case is probably not purpura, 
but it serves to illustrate the direction in which 
lachesis may be applied with advantage. It 
was published by Dr. Constantine Hering in 
ArcJiiv. fur die Horn. Ileil/iunst, vol. xvi : 

5. A young man, weakened by disease and 
by medicine, bad suffered much from pains in 
the bones (probably mercurial syphilitic) of 
the right arm, which had been still further 
weakened by the fracture of the clavicle. After 
he had been cured of this pain as well as of 



CLIJSTICAL CASES. 103 

caries of the upper jaw, and had remained 
perfectly well during four months of the coldest 
weather, that is, from December to March, he 
was attacked without any ascribed cause, 
except that he had taken a piece of ice in his 
hand, suddenly,one morning, with the following 
affection : Swelling of the back of the right 
hand, extending down the lingers ; the whole 
after a few minutes became quite livid. After 
being wetted with hot brandy it went off : but 
after some days it returned as suddenly as be- 
fore, and much more severe, and then it 
appeared every day, each day earlier than the 
foregoing, and continued three or four hours. 
It begins with severe itching and creeping ; the 
hand becomes blue and gradually darker, and 
has the appearance of a contusion on the worst 
part, but more transparent ; it is at parts 
mottled ; the hand looks as if it was stuffed, it 
is so hard. The affection now goes from the 
middle of the back of the hand, over all the 
fingers, the hand is ice-cold, but seems to him 
burning hot, it is very sensitive to pressure, 
and he can bear nothing to lie upon it ; burning 
and pricking in the finger ends ; the heat of the 
stove relieves the pain, but increases the 
-creeping sensation. Lachesis cured. 



104 

ARSENICUM. 

Skin. — Petechia. Ecchymoses. 

1. Small ecchymoses, or rather petechias 
[Roth's collection of poison cases.] 

2. Blue spots on the abdomen, genital or- 
gans, and white of the eye. [Kaiser ; poison- 
ing of a whole family by arsenic] 

3. Purple petechia on chest and neck. [A. 
McLeod ; in Edinburgh Medical and Surgi- 
cal Journal, vol. xv, page 553.] 

4. Eruption resembling red petechia, from 
the size of a flea bite up to that of a lentil, 
sharply circumscribed, in the evening, painful, 
dry, moist, and burning after scratching. 
[Symptom from Hahnemann.] 

5. Numerous petechial spots over the skin of 
the trunk and thighs. [Dr. Vitry ; Ann. d } Hy- 
giene et de Medicin. Legal, 1846,] 

6. Small spots of purpura on neck. [A fam- 
ily poisoned by arsenic in food. Dublin 
Quart, Journal of Medical Science, 1851 ] 

7. Purple patches gradually covered his arm 
and side. [From making arsenical candles. 
Dublin Medical Press, vol. xiii, page 61.] 

Concomitants. — Great restlessness ; rapid 
emaciation ; burning thirst. 
Burning pains everywhere. 



COMMENTS. 105 

(Edematous tendencies. 

Excoriating discharges ; eyes, nose, ears. 
Suffocation when lying ; must sit up. 
Constant uneasiness ; cannot lie still ; must 
change position. 
Frequent starting during sleep. 
Worse at night ; relieved by warmth. 

Comments. — Arsenicum presents in a very 
characteristic manner the more salient features 
of purpura hsemorrhagica ; petechia occur on 
various parts of the body, and multiple 
haemorrhages from the various organs. It holds 
a position very little inferior to the serpent 
venoms, and corresponds to a very dangerous 
form of the disorder. Arsenic causes a pro- 
gressive decrease in both the white and red cor- 
puscles of the blood. The petechia seen upon 
the skin are accompanied by ecchymoses in the 
lungs, pleurae, pericardium, and heart. In 
chronic arsenical poisoning there is fatty de- 
generation of both the liver and the kidney. 

Clinical. — Jahr, in Forty Years'" Practice, 
relates the following desperate case, which is 
interesting in itself, and because it illustrates 
how even the most competent sometimes final 
cure by a fluke, after apparently well-selected 
remedies have failed. 

1. One evening I was called to a young lady 



106 ARSENICUM. 

who had been living in extreme indigence for 
some six weeks, and had only had a very 
Scanty supply of nourishment on three or four 
days in the week. One of her relatives con- 
ducted me to her to relieve her of a terrible 
menorrhagia that had weakened her to such an 
extent that she was unable to leave her bed. I 
prescribed china 30th, two globules in a few 
tablespoonf uls of water, a teaspoonful of which 
solution was to be taken every half hour until 
I should see her again early next morning. 
Next morning the menorrhagia was not only 
unimproved, but haemorrhages from the nose 
and mouth had supervened ; on the skin general- 
ly no spots could as yet be perceived. I now 
prescribed phosphorus 30th, two globules in 
water, to be taken in the same manner as the 
china, and, in case of improvement, to be con- 
tinued every hour until my evening visit. 
During the day I received a written message 
that the haemorrhage continued to increase all 
the time, and that the patient fell from one 
syncope into another. Not being at home 
when this message arrived, I did not see my pa- 
tient again until evening, when I found her in 
a most desperate condition. With the haem- 
orrhages from the uterus, mouth and nose, 
spots and blisters of the size of a dollar had 
become associated in the mouth and on the 



CLINICAL CASES. 107 

skin of the whole body ; pure blood oozed 
from these spots, and the patient, who still re- 
tained her full consciousness, lay like a corpse, 
with death-like pallor of the hippocratic coun- 
tenance, dull, lustreless eyes, and icy-coldness 
of the whole body, as if perfectly inanimate. 
Although I had not a ray of hope of saving 
her, yet I placed two globules of arsenicum, 
30th. dry on her tongne, leaving at the same 
time a watery solution of the same dose, with 
instructions to administer it in the same man- 
ner as either of the other remedies, and, if 
anything untoward should happen, to send for 
me in the night. I was not sent for, but next 
morning at seven o'clock I received a note that 
had been written the evening previous, shortly 
after my departure, and wherein I was re- 
quested not to trouble myself with any further 
visits, and that an old-school physician had 
been sent for. I heard nothing farther of my 
patient and thought her in her grave, when 
six months afterwards a young couple walked 
into my office, and I was asked by the young 
man, who was a stranger to me, whether I re- 
membered a dying young woman whom I had 
treated for haemorrhage. I replied yes, and 
said, moreover, that if no other physician 
had been sent for, and my last prescription 
had been continued, she would j)robably still 



108 ARSENICUM. 

be in the land of the living. " She did con- 
tinue your medicine," now interrupted the 
pale young woman, but who otherwise seemed 
to .enjoy good health; "she continued your 
medicine, and the medicine of the other doc- 
tor was poured out of the window, and this is 
the reason why she now stands here before jou y 
restored to life and health, and married, and 
wishes to know how much she owes you." 
When I heard these words I was scarcely able 
te believe my senses ; nevertheless, she was the 
identical person. The more I looked at her 
and heard her talk, the better I recognized the 
voice and features of my former patient, and I 
now heard for the first time that the physician, 
whom one of her relatives had sent for, had told 
the family that nothing could be done for the 
young lady, and that she would certainly die 
over night ; nevertheless, he was willing to 
leave a prescription and to call again the fol- 
lowing morning. Before his prescription ar- 
rived from the pharmacy the two globules 
of arsenicum had already effected a consider- 
able decrease of the haemorrhage, and the fam- 
ily concluded to continue my watery solution 
of arsenicum, and, the improvement pro- 
gressing all the time, to have it renewed by 
the apothecary, so that eight days after my 
last visit the patient was completely restored. 



CLIIICAL CASES. 109 

Such miracles are performed even by the 
smallest doses of appropriately-selected reme- 
dies. 

Dr. Geo. M. Ockford reported the following 
case in the American Homoeopathist, August, 

1885. 

2. I have had but two cases of purpura all told. 
One was in a woman, aged sixty-five, w r ko had 
always worked very hard and lived very poorly, 
and whose system had been completely broken 
down by these adverse influences and numer- 
ous attacks of intermittent fever. She was 
anaemic and cachectic. Before the appearance 
of the purpuric spots there had been languor, 
a profound sense of weakness and weariness, 
and considerable digestive derangement, includ- 
ing pain in the pit of the stomach and tender- 
ness on pressure. The purpuric extravasations 
were mainly upon the extremities, although 
one or two spots appeared upon the body, but 
no petechia upon the face were observed. I 
gave her arsenicum, 3 x trituration, which 
speediJy removed the extravasations and cured 
the case. 

Prof. A. E. Small, M. D., has sent me the 
following report of a case : 

3. A young man, 18 years of age, nervous- 



110 ARSENICUM. 

bilious temperament, contracted a cold live 
years ago last March. After a few days a feb- 
rile condition ensued, marked by a peculiar 
prostration. He had been for some time at 
hard study in preparation to enter Harvard 
University, and the chief symptom manifest at 
first, appeared to be exhaustion from too close 
application to his studies. After a few days, 
however, spots of purpura were noticed on his 
arms and body, and epistaxis was an accom- 
paniment. These ecchymosed spots became 
quite numerous, varying in size, as that from a 
dime to a half-dollar. The case was diagnosed 
as genuine purpura haemorrhagica, or morbus 
maculosus Werlhofii. The extreme weakness 
of this patient suggested the employment of 
arsenicum, which w T as administered in the 
third decimal trituration, twice a day, while 
the external surroundings of the patient were 
made as pleasant as possible and favorable to 
recovery. China was also prescribed after 
arsenicum, and finally, bryonia. The patient 
recovered, and entered Harvard College, but 
was obliged to leave during tine senior year, on 
account of threatened tuberculosis. He has 
since been under my care, and I date the com- 
mencement of his lung trouble to the siege of 
purpura he passed through before he entered 
college. 



CLINICAL CASES. Ill 

The following case was reported to me by 
Dr. W. M. L. Fiske, of Brooklyn, New York: 

4. The patient was a foreman in the shoe 
shop at the Kings County penitentiary. He 
had an attack in four successive years. In none 
of these were the constitutional symx3toms very 
marked. He recovered under arsenicum. 

The following case, by Dr. S. D. Jones, is 
from Hoyne's Clinical Therapeutics, vol. I, 
page 356 : 

5. A gentleman, thirty-five years of age, had 
typhoid fever for six weeks ; had been treated 
allopathically, and had been pronounced con- 
valescent, but relapsed and became delirious ; 
made vigorous efforts to get away, believing 
that those around him were enemies, and were 
endeavoring to take his life ; delirium contin- 
ued about three days. At this period small 
purple or bruised-like spots made their appear- 
ance upon his body, arms and legs. These 
spots turned almost black, and spread, many 
of them, to the size of the hand, and extended 
over bis body, ^especially his chest and abdo- 
men ; profuse haemorrhage set in from the nose 
and left eye ; after a few days both ears dis- 
charged small quantities of blood ; the haemor- 
rhage from the nose and left eye was so great 
that there were fears of bleeding to_death. This 



112 ARSENICUM. 

bleeding was arrested after a few days, when 
the patient sank into a comatose state, and be- 
came entirely unconscious ; lay with his eyes 
rolled back, eyelids and mouth open ; pulse 
120, small and corded ; surface hot and dry and 
a general ansemic condition of the entire body ; 
tongi^fe dry and covered with a dry, brown 
crust ; bowels constipated. Gave aconite 3d 
dilution, in water every hour, when the pulse 
was reduced to 98, and softer. Then gave ar- 
senicum, 3d trituration, in water, every four 
hours. Compressed the chest and abdomen 
with cloths wrung out of tepid water, in 
which tincture of arnica has been mixed, in 
the proportion of a teaspoonful to a pint of 
water ; extremities rubbed and kept warm by 
w T rapping them in flannels, and a jug of hot 
water to the feet ; enemas of tepid water to the 
bowels every day. Forty-eight hours after a 
perceptible change had taken place for the 
better ; pulse 97, fuller and more soft ; con- 
sciousness gradually returned. Continued the 
treatment, except the compress, which was con- 
tinued about one week. Patient gradually and 
steadily improved. 

Dr. C. Heinigke reported in the Alle. Horn. 
Zeituny, 81, page 27, as follows : 

6. A case of red, infiltrated spots, which 
burn, cured by arsenicum 6. 



113 

SECALE. 

Skin. — 1. Petechia. Large eccliymoses. 
Gangrenous blisters. Blood-boils. [Ejchtek ; 
Spec. Therapia, Tome vi.] 

2. Spots like flea-bites, on the feet, lasting 
eight weeks. [Ant. Scrinc ; in Satyr, med^ 
Sites. Spec, iv., Obs. v, page 35.] 

3. Petechia. [Haase ; Handbucli der cliron. 
Kranklieiten, Tome ii.] 

4. Petechial exanthema and furuncles on the 
lower limbs ; outer parts of the limbs, especial- 
ly the fingers, turn dark-blue, become gangre- 
nous and die altogether ; the gangrene rapidly 
extended over other parts of the body, was not 
confined to fleshy parts, but affected the bone, 
so that often the gangrenous parts fell off. 
[Dreysig ; Handbucli der med. Diagnostica, 
Band 2.] 

5. An eruption of livid spots broke out over 
the body. [Account of the Ergot Epidemic in 
Germany, 1770 ; Prof. A. T. Thomson, Lec- 
turer on Medical Jurisprudence, London Lan- 
cet, Sept, 9, 1837.] 

6. The skin livid on account of slow action 
of the capillaries. [Effects of 40 minims of 
the oil, in a young man, aged twenty ; Dr. 



114 S E C A L E. 

Charles Hooker, Boston Medical and Surgi- 
cal Journal, 1834, page 300.] 

Concomitants. — Sensation as of something 
creeping on or under the skin. 

Coldness of the surface of the body. 

Cold, clammy condition of the skin. 

Extreme aversion to heat. 

Heat applied to any part of the body makes 
the patient worse. 

Anxiety and fear of death. 

All the senses benumbed ; sight, hearing, 
etc. 

Eyes sunken and surrounded with a blue 
margin. 

Dimness of vision ; everything looks black 
when moving the head ; when rising up in bed 
everything turns black before the eyes. 

Roaring in the ears with great difficulty of 
hearing. 

Constant nose-bleed. 

Face pale, sunken, hippocratic. 

Lips bluish. 

Speech slow and weak. 

Haemorrhages from the stomach, bowels, 
kidneys, uterus. 

Anxious respiration. 

Constant sighing. 

Pulse small, rapid, and intermittent. 



C O 31 31 E 1S T T S . 115 

Restlessness : prostration ; extreme debility ; 
rapid sinking of strength. 

Comments. — The evidences of the purpura- 
producing power of secale are sufficient, but I 
have not been able to trace them satisfactorily 
to myself. The half dozen observations cited 
above prove how serviceable it is likely to be 
in those cases in which the well-know charac- 
teristics of the drug are present. 

Clinical — The following very interesting case 
was reported by me, in the American Homozop- 
athist, August, 1885 : 

1. On June 17, 1881, I was called in to see a 
German woman, aged 55, living on 29th street, 
opposite the old Hudson River Railway sheds. 
I had known the family for some time, as a 
son, a jeweler by trade, had a peculiar trouble 
of the heart. The old lady had not been ill for 
many years, but had for months complained of 
a numbness of the left leg and foot, for which, 
however, she refused treatment, believing she 
could work it off. She was one of those dried- 
up little specimens, with a leathery skin, which 
we so often see among the poor class of Ger- 
man immigrants. The block on which they lived 
was notorious for its bad sanitary condition, 
and during the hot weather which was now 
prevailing funerals were a daily occurrence. 



116 S E C A L E. 

She had been ill for several days, but refused 
to have medical attendance, as she had a great 
scorn for doctors. I was at the time attending 
that anomalous case of puerperal fever which I 
reported in the New York Medical Times for 
September, 1881, cured by calcarea carbonica 
200, in the next house, and her daughter, see- 
ing me pass the door, called me in to see her 
mother. The old lady refused to look at me 
or speak to me, but by using my eyes and from 
the report of the family I gathered the follow- 
ing facts in the case : She had had for two or 
three weeks a sensation on various parts of the 
skin, but most pronounced on the lower ex- 
tremities, as of insects or vermin creeping 
about on her. She also complained of lack of 
sensation in her left foot and in both hands, 
which induced her to continually rub them with 
a piece of flannel. She had been taking some 
kind of German medicinal tea, the composition 
of which I did not learn. She evinced the 
greatest objection to lying in bed, and although 
very weak required constant supervision and 
persuasion to keep her there — and this when so 
exhausted that the attempt to get up only re- 
sulted in her sliding down upon the floor. 
Equally marked was her repugnance to being 
covered; and when I first saw her she lay in bed 
with nothing on but a short chemise and her 



CLINICAL CASES. 117 

native modesty. What attracted my attention 
first was the shrunken and anxious expression 
of her face, and next the peculiar appearance 
of her feet and legs. Both feet and legs up to 
the knee were covered with bruises, or what ap- 
peared to be such. These were much worse on 
the left side, where the toes were actually 
black. That this was not a mere local trouble 
was shown by the presence of ecchymosesupon 
the forearms and upon the buttocks. More 
alarming, to the family at least, was the emeto- 
catharsis. The vomiting and purging occurred 
simultaneously and involuntarily, nearly hour- 
ly, but neither were very copious. The dejected 
matter was watery, nearly colorless, and pre- 
ceded by colic and rumbling in the abdomen. 
Her skin was cold and clammy. She had a 
great thirst and was clamorous (or at least had 
been until her voice became so husky and weak 
as scarcely to be heard) for iced water, lemon- 
ade, beer, anything that was cold. She had 
had bleeding from the nose, but its character 
and frequency I could not learn. The urine 
was suppressed. Of course, there was never a 
doubt about the remedy ; if in so desperate a 
case any drug could save it was secale. What- 
ever the remedy did do it was not a " faith- 
cure/' either on account of the doctor's mental 
attitude or the patient's; and I expected to 



118 S E C AL E. 

find her dead on my return in the evening. 
Secale was given in the sixth trituration, dry- 
on the tongue, every ten minutes for an hour, 
and afterwards half-hourly ; a higher potency 
would have been given if I had had it with me. 
When I saw her four hours later, the vomiting 
had ceased, but the bowels remained about the 
same except in frequency. The medicine was 
commenced at 2:30 P. M., and the diarrhoea 
ceased at about midnight. The reaction was 
followed by a slight fever, for which I gave, the 
next day, aconite (this now I believe to have 
been a mistake), returning again to secale in 
the evening, on account of her having had a 
diarrhoeic stool. The purpura gradually faded, 
and quite disappeared in eight or nine days. 

2. Prof. J. R. Kippax, M. D., writes me that 
the hypodermic injection of the fluid extract 
of ergot, in ten mimin doses, every six hours, 
did good service in a case in which the pur- 
puric spots were dark, confined mostly to the 
extremities, and attended with profuse uterine 
haemorrhage, after both erigeron 3 x and se- 
cale 3 x, internally, had failed to relieve. 

Dr. J. L Gage, of Vassar, Mich., published 
the following case in the American Homoeo- 
pathist, November, 1885, as showing the power 
of a proper remedy to cure : 



CLINICAL CASES. 119 

3. A few years ago a man aged about fifty fell 
and broke the tibia above the ankle. He was 
helped up, and walked with help some rods, 
and being assisted into a wagon, rode home, got 
out, and walked into his house. The broken 
ends of the bones lacerated the soft parts, so 
in two or three days the leg was black all 
around the ankle, except a strip about an inch 
wide on the under side. It was a question 
whether the leg should come off, I determining 
to try and save the leg, and did. Secale 6, 
was the chief remedy given. There was slough- 
ing, some deep, some superficial ; but it healed 
readily, and he had a good leg again. In gan- 
grene and purpuric haemorrhages secale is most 
frequently our main reliance. 

CHINA. 

Skin. — Petechia. Purpura hemorrhagica. 

1. A woman, 50 years of age, took, every six 
hours, 10 centigrammes of sulphate of quinine, 
for neuralgia. The next day the dose was in- 
creased to 15 centigrammes, and a blister was 
applied to the axilla. The next day, the part 
blistered was all black ; a sanguinolent serosity 
exuded from it ; more than that, the whole 
body was covered with spots of purpura. 
Quinine was suspended and the mineral acids 
substituted for it. At the end of nine days all 



120 C H I ]N T A . 

the body was well ; the axilla was healed at the 
end of fifteen days. Quinine was subsequently 
prescribed for toothache, and the purpura reap- 
peared. In this case, and in those that followed, 
the quinine was chemically pure ; and hence 
must be regarded as the only cause of the 
phenomena observed. [Dr. Vepatt, in Bulletin 
Gen. cle Ther., Ixxii. page 140.] 

2. A woman took quinine to relieve herself 
of a tertian fever. The second day she had 
nose-bleed ; the body was covered with spots of 
purpura ; the gums bleeding. The quinine was 
suspended, and mineral acids given for three 
days ; then, a laxative ; and at the end of eight 
days the spots had disappeared. [Ibid.] 

3. A boy 12 years of age, presenting a gen- 
eral debility, took quinine. At the end of a 
few days purpura developed itself ; but the 
quinine was continued some time, to try its 
action. The purpura increased ; the gums 
bled. The quinine was stopped, saline purga- 
tives given, and in ten days the skin was well. 
[Ibid,'] 

4. A man, who took quinine for a masked 
fever, presented no trace of a cutaneous affec- 
tion, even at the end of fifteen days. Attention 
being called to the subject, it was thought that 
he wo aid escape ; nevertheless, three days 



CONCOMITANTS. 121 

after, he had twenty spots upon the shoulders. 
[Ibid.] 

Concomitants. — Excessive sensitiveness of 
the nervous system ; all the symptoms are ag- 
gravated by the slightest contact, by motion, 
or by mental or physical effort. 

The brain beats in waves against the skull. 

Ringing in the ears. 

No desire for eating or drinking. 

Body sore all over. 

Perspiration very profuse ai*d debilitating, 
especially at night. 

Profuse sweat during sleep, or on being cov- 
ered up. 

Perspiration on the side on which he lies. 

Jaundice. 

Periodical, or intermitting, symptoms. 

Prostration, with neither thirst nor hunger. 

Debility following the loss of blood or other 
fluids. 

Relationships. — Best suited to swarthy per- 
sons, u broken-down " constitutions and old 
women. 

Clinical. — The following case was reported 
by the writer, in the American Homoeopatlvist, 
for August, 1885 : 

1. Mrs. L. M. B., a native of England, aged 37, 
resident in New York about nine years ; bru- 



122 CHINA. 

nette ; large and fleshy ; originally of a ruddy 
complexion, bat now pale and anaemic ; the 
mother of four children, and in her last confine- 
ment, about one year previous to the date here 
mentioned, lost an enormous amount of blood, 
so much so as to endanger her life, since which 
time she has been feeble and dispirited ; her 
menses have always been rather free, and at 
times menorrhagic. The husband, who had 
formerly been a good workman, had for the 
past year and a half taken to drink, and the 
family had sunken into absolute poverty. The 
wife had endeavored to support herself and 
children by taking in coarse washing, and her 
system was much run down by over work, in- 
sufficiency of food, and constant anxiety. To 
these influences was probably due the severity 
of the haemorrhage at her last confinement. 
The child, unfortunately, lived until its tenth 
month, when it died of capillary bronchitis. 
The exhaustion caused by nursing this child, 
and her untoward surroundings, brought on a 
low fever, for which she received large doses of 
sulphate of quinine from a dispensary doctor. 
This was the condition of things when I first 
saw her, in March, 1881. Through a charitable 
organization I secured the removal of the fam- 
ily from the wretched room they occupied in a 
rear building on Eleventh avenue, near Twenty- 



CLINICAL CASES. 123 

eighth street, to much healthier and cleaner 
quarters on Twenty-fourth street, near Ninth 
avenue. Work was found for the husband, 
who promised to reform, and who did main- 
tain tolerably decent habits for some months 
thereafter. 

A study of the patient's condition led me to 
give natrum muriaticum, both because she had 
been dosed heavily with quinine, and on ac- 
count of various symptoms which corresponded 
with its pathogensy ; but, although it was con- 
tinued for two weeks, in varying potency, 
with a milk and beef- tea diet, I saw no benefit 
from it. In some ways the patient was better, 
but these changes could well be ascribed to her 
improved surroundings and dietary. 

She had a fever every day, beginning late in 
the forenoon, without chill, continuing until 
evening, and passing off with a copious sweat 
which lasted until near morning. The fever 
would vary day by day as to the hour of com- 
mencement, sometimes as early as ten o clock, 
or as late as one o'clock, but never the same. 

During the fever she was stupid, and could 
not be depended upon to describe her sensa- 
tions. In the morning she had a bursting 
headache, and the congestion to the head ap- 
parently continued all day ; but as soon as the 
perspiration set in all the untoward symptoms 



124 CHINA. 

disappeared, she became lively and bright, 
said she felt well and free from pain, and drank 
milk frequently and greedily. I stuck to na- 
trum longer chan I otherwise should on account 
of one symptom — fever blisters on the lips — 
but, finally, changed to mix vomica. This, 
ignatia, rhus tox., and lycopodium were given 
during the next (third) week of treatment. The 
symptoms varied considerably, and I was 
making a rather hopeless stern-chase after 
them, and felt very much discouraged, when a 
new phase presented itself and altered the en- 
tire outlook. Her menses came on the 16th 
day of treatment, and were profuse. The dis- 
charge was watery, and contained numerous 
dark coagula. On the 21st day, the menses 
continuing, and the patient being now very 
weak and apathetic, I was shocked to find that 
there had appeared spontaneously several ec- 
chymoses on the left thigh about the size of a 
silver dollar, and smaller ones on the leg, foot 
and along the lumbar region. Phosphorus 12 
was given, bi-hourly. 

22d day. The ecchymoses have spread con- 
siderably, the old ones enlarging and many 
new ones forming. Her face is shrunken and 
livid> with eyes surrounded by heavy blue 
lines ; sight dim and uncertain ; noises in the 
ear, like distant bells ; very apathetic, and 



CLINICAL CASES. 125 

either does not reply at all to questions, or 
slowly, as if she did not fully comprehend ; de- 
sires continually cold lemonade, and refuses 
milk and the beef- tea, which disagree, causing 
eructations ; urine scanty, turbid, and with a 
red-brown sediment, diarrlioea of bloody mu- 
cus, scanty, infrequent, painless ; she wants 
to be bolstered up in bed on account of op- 
pression in the chest, when lying down ; skin 
cold, clammy and greasy ; temperature (axilla), 
103. 4 Q F. 

In the presence of so grave a condition, I 
naturally hesitated as to the best course to 
pursue. Evidently phosphorus was doing no 
good. Various remedies, which had seemed 
indicated — at least, they were not given thought- 
lessly and without much study— had been given, 
nevertheless, without result. I had avoided 
china, which had several times been called to 
my mind by symptoms in the case, because she 
had been so recently deluged with it. * How- 
ever, I could not disguise from myself the 
many points of resemblance between this drug 
and the case before me, and on studying its 
pathogenesis carefully I became convinced that 
if any remedy was capable of saving my pa- 
tient it was china, and china only. China has 
the following : 

Indifference ; apathy ; ill humor. 



126 CHINA. 

Dislike to all mental or physical exertion. 

Slow train of ideas. 

Intense throbbing headache — after loss of 
blood. 

Sight dim and faint. 

Fine ringing in ears. 

Hardness of hearing ; hamming in ears. 

Nose-bleed ; ringing in ears ; face pale. 

Face pale, hollow or livid ; blue around the 
eyes ; hippocratic. 

Longs for sour, cooling things. 

Violent thirst for cold drinks. 

Sour eructations after milk. 

Heartburn after milk. 

Haematemesis ; weak, pale, cold. 

Stools ; bloody, painless. 

Urine ; turbid, scanty; depositing brick-dust 
sediment. 

Uterine haemorrhages, ringing in ears, faint- 
ing, coldness, loss of sight ; discharge of dark 
clots. 

Menses dark, coagulated ; or pale and watery, 
with dark coagula. 

Can not breathe w T ith head low. 

Haemoptysis. 

Fever, long-lasting; and coming on at irregu- 
lar intervals. 

Sweat ; partial, cold, or profuse ; greasy. 

Haemorrhages from mouth, nose, or bowels ; 
wants sour things. 



CLINICAL CASES. 127 

Although the pathogenesis did not show ec- 
chym'oses on the skin, or elsewhere, and I did 
not at that time know of the recorded poison- 
ings in which purpura developed (Vepau), 
nevertheless, I determined, in view of the 
origin of the pathological state of the patient, 
resulting as it did from overlactation fol- 
lowing excessive parturient haemorrhage, and 
the remarkable coincidence in the concom- 
itants, to give china, and in a high po- 
tency. I gave half a dozen pellets of Car- 
roll Dunham's 200th, about noon, to be fol- 
lowed by a similar dose every four hours. 
Very little change was noted during the 
first twenty-fours, except an improvement in 
the condition of the bowels ; but on the 23d 
day the mental state was altered for the better 
in a marvelous degree, and the fever tempera- 
ture was only 100° F. All her apathy was 
gone, and she answered promptly and pleas- 
antly all interrogatories. She took nourish- 
ment freely, had no perspiration at night, and 
slept quietly and soundly. 

24th day. No new ecchymoses have ap- 
peared since china was given, and many of the 
old ones are fading, changing to a mottled and 
greenish shade. She is now taking two quarts 
of milk daily ; beside beef-extract. Bowels 
and kidnej^s acting normally. Temperature at 



128 c II I x a . 

noon, 99.4° F. ; but she is not conscious of any 
fever. She is very weak, but her mind is 
bright, and her spirits high. 

27th day. She has continued to convalesce 
nicely. No fever to clay for the first time in 
two months. Appetite good and 'functions all 
normal. The ecchymoses are fading slowly. 

32d day. She was up and moving about the 
room to-day. Has had an ounce of Speer's 
port wine, three times a clay, with her meals, 
since the 29th. Is in all respects well except 
extremely weak. Has had no medicine since 
the 28th, except five drops of dialyzed iron in 
half an ounce of water, at bedtime. 

KHUS VENENATA. 

Skin. — 1. There had appeared red spots, 
varying from a half to two inches in diameter, 
especially on the legs below the knee ; these 
pained her, and underwent all the changes as 
if caused by a fall or blow, namely, the red 
changed into a bluish, then greenish-yellow 
color, leaving finally spots of a little darker 
tint than the healthy skin. [Poisoning by 
using a branch for a fan ; Dr. Oeiime, in the 
JSew England Medical Gazette, vol i, page 
121.] 

2. There appear upon the skin small ecchy- 



PATHOGEXEST. 12S? 

moses ; the expectoration has a bloody tinge ; 
the stools rarely contain blood. [Dr. Wurmb.] 

3. It affects the blood and the blood-making 
organs similarly to the ijoison of typhoid, 
scarlet fever, and erysipelas, producing ecchy- 
moses of the skin, etc. [Dr. W. H. Burt, 
Physiological Materia Meclica, page 787.] 

4. Mr. C. H. B., aged forty-one years ; per- 
fectly healthy ; strictly temperate ; ha'd not 
a day's sickness for twenty-five years. He was 
poisoned by handling rhus vines. Two days 
after handling the vine the usual vesicular 
rash appeared upon the skin of both hands, 
particularly between the fingers, confirming the 
usual physiological action of this drug. The 
third day the gums commenced bleeding, ee* 
chymosed spots, of different sizes, appeared 
under the surface of the skin in the different 
parts of the body, particularly the legs, 
on the conjunctival membrane, on the Ver- 
million border of the lips, and upon the 
surface of the tongue. On the seventh day 
haemorrhage commenced from the bladder 
and continued seven days. Each passage 
of urine, which was free and easy, four 
or five each day, contained a good supply of 
blood. The haemorrhage from the gams was a 
continuous oozing, which lasted fourteen days. 



130 RHUS. 

The amount of blood from the gums and blad- 
der was very great, giving the patient a marked 
anaemic appearance. The pulse and tempera- 
ture were not altered from the normal stand- 
ard until the fourteenth day, when he passed 
through a critical period ; the temperature rose 
to 108° Pahr., pulse 140, respiration rapid, 
which condition broke up by passing into a 
gentle sweat. After this critical period, the 
fourteenth day, the bleeding from the gums 
and bladder rapidly disappeared, and he 
quickly regained his usual strength and vigor. 
During the two weeks of bleeding his appetite 
was good, no headache, slept well, action of 
the skin normal,- and was even in good spirits. 
The treatment consisted in maintaining abso- 
lute rest in bed, a nourishing diet, and the ad- 
ministration, one remedy at a time, of bella- 
donna, terebinthina, hamamelis, sulphuric 
acid, china, and, on the fourteenth day, the 
free use of the tincture of aconite. Consulta- 
tions were had with Drs. C. Neidhard and M. 
Macfarlan, who each confirmed the diagnosis, 
and related similar cases from the action of 
rhus. [Dr. Richard C. Allejst, in Transac- 
tions of the Homoeopathic Medical Society of 
Pennsylvania, 1883, page 267.] 

The usual eruption of rhus varies in severity 



CONCOMITANTS. 131 

from the blush of erythema to malignant 
phlegmonous erysipelas. 

Concomitants. — Great weakness and. para- 
lytic heaviness of the legs and feet. 

Great debility, paralytic weakness and. sore- 
ness, especially when at rest. 

Great restlessness and uneasiness ; must con- 
stantly change position ; especially at night. 

Burning and itching over the whole body. 

Crawling or prickling sensation over the sur- 
face of the fingers ; especially the tips. 

Tongue red, dry, and cracked ; or sore, with 
red tip. 

Great thirst for cold milk. 

Sensitiveness to the (cool) air. 

Sleeplessness with restlessness. 

Clinical. — The subjoined case, cured by rlius 
venenata, is an instructive illustration of how 
to find the true homoeopathic remedy. It was 
not until pathological lore was ignored, and 
the prescription based solely on the symptoms 
of the case, that a cure was found. I reported 
it in the American Homoeopatliist, August, 
1885: 

James S.. aged 29 ; of the bilious type, lean 
and spare, but not emaciate ; by trade a carpen- 
ter, but at present employed on the elevated 
railway ; married ; had intermittent fever sev- 



1 32 RHUS. 

eral years ago, and is somewhat subject to rheu- 
matic attacks ; applied at the Manhattan Hos- 
pital for treatment, October 10, 1879. He com- 
plained of an intense headache, describing the 
pain as throbbing. He felt dizzy when turn- 
ing or stooping, but had no nausea. The con- 
junctiva was reddened and dry. The face 
somewhat flushed, temp. 100.2; pulse 78, re- 
spirations 20. The pulse was rather hard, and 
the heart beat with a sharp click. He was 
given glonoine 12, every two hours. 

October 11. Headache no better. The face 
more deeply congested ; the conjunctiva about 
as yesterday, but the eyes look more staring. 
The brain seems to have a wavy, undulating 
motion whenever he stirs, but especially on 
stooping. He refuses to take his medicine, as 
he imagines it disagrees with him, and thinks 
he has been poisoned. Complains of pain in 
the left wrist and throbbing in the hand, which 
seemed to be synchronous with the throbbing 
in the head. Temp., 100.6 ; pulse, 82, and of 
about the same general character, respira- 
tions, 20. 

A study of the pathogenesy of glonoine con- 
firmed the impression that it was the remedy 
most homoeopathic to the case. Glonoine 
has — 

Throbbing ; in temples, in vertex, in occi- 
put, in whole head. 



CLINICAL CASES. 133 

Severe pain in the forehead, throbbing in 
the temples, worse from walking. 

Head aches worse ; from shaking or jarring the 
head, stooping, bending it backwards, after 
lying down, when ascending steps, in damp 
weather, in the sun. 

Vertigo worse : from stooping, or moving the 
head. 

Fear: apprehensive of approaching death; 
fears she has been poisoned. 

Face flushed, hot, especially about the eyes 
and forehead, with headache ; livid, purple. 

Eyes injected, red, protuding, wild, staring. 

Pulse ; accelerated, increased during head- 
ache ; quick, small, irregular. 

Weakness of wrists after headache. 

Rheumatic pains in fingers of left hand. 

Feels pulse in fingers. 

Thus assurred of the homceopathicity of the 
remedy, although no improvement had taken 
place, I resolved to continue it, in a higher po- 
tency. Gave glonoine 200, every four hours. 

Oct. 12. Patient no worse ; remedy continued 
as before. 

Oct. 13. Headache very much improved, and 
the face and eyes less congested ; but the 
rheumatoid pains in the wrist had extended to 
the elbow, and were much complained of. 
Temp., 101.5 ; pulse, 86 ; respiration, 20. Small 



134 RHUS. 

petechial spots, like flpa-bites, were noticed on 
the forearm and wrist, and this led to an exam- 
ination of the skin elsewhere. 

The patient now mentioned, for the first 
time, that he had had for some days similar 
spots upon the legs. The legs from the knee 
to the ankle were covered with numerous small 
ecchymoses of varying size, and in some 
places, where several had coalesced, as large as 
a silver dime. The knee of the left leg was 
tender and stiff, and the whole leg was perva- 
ded with a peculiar sense of weakness and 
numbness. The patient was very restless and 
apprehensive ; felt drowsy, but could not 
sleep ; the bowels, which previously had been 
regular, were now for three days constipated, 
with bitter taste, dry tongue, sore gums and 
inappetence. 

The petechia, the rheumatic pains in the 
wrist and knee-joint, the sense of weakness 
and prostration, the constipated bowels, the 
symptoms of the buccal cavity, the continued 
slow fever, and the insomnia with drowsiness, 
seemed to point clearly to phosphorus, which 
was given, bi-hourly, in the 6th trituration. 

Oct. 14. Most of the symptoms remain 
about the same, but the pulse is 92 and weak, 
and the temperature has risen to 102.28. The 
petechia} have increased in number and size, 



CLINICAL CASES. 135 

and have spread to the thighs and back. A 
slight nose-bleed occurred during the night. 
He feels greatly prostrated, but is restless 
and anxious, and his sleep after midnight was 
disturbed by vivid dreams, in which he 
thought he was climbing a great mountain, 
carrying a heavy load. The urine was scanc 
and dark. Not seeing any clear indication for 
a change, phosphorus was continued until the 
16th inst., in varying potency, third, twelfth, 
thirtieth, and two-hundreth ; but the patient 
grew slowly and manifestly worse, especially 
the pains and prostration. 

Oct. 16. Temp., 102.4; pulse, 90, weak and 
trembling ; respiration, 20, shallow, as if un- 
able to draw a full breath. The ecchymoses 
had extended over the entire body, and were 
accompanied by much itching. The pain in 
the joints very severe, making him extremely 
irritable and restless. During the night he had 
had a copious nose-bleed. The urine scanty, 
with coffee-ground sediment. 

An error in the remedy used being now ap- 
parent led to a further study of the case. The 
character of the pain so closely resembled that 
of rhus toxicodendron that its pathogenesy 
was examined, developing the following cor- 
respondences : 

Fear of death ; fears he will be poisoned 



136 RHUS. 

Vertigo, worse from turning or stooping, or 
when rising from lying. 

Headache, rush of blood to the head, with 
throbbing ; restless ; face red. 

Eyes red and inflamed. 

Epistaxis of coagulated blood, worse at 
night. 

Face liery red ; dark-red ; with burning. 

Food, especially bread, tastes bitter. 

Tongue dry, red, cracked. 

Hunger without appetite. 

Urine diminished ; discharges a few drops of 
blood-red urine. 

Pulse accelerated, weak, faint and soft ; 
trembling or imperceptible. 

Tearing and burning in the shoulder and 
arm/ 

Pains felt mostly in the knee. 

Swelling and stiffness of the joints. 

Rheumatoid pains in the limbs, with numb- 
ness and tingling. 

Great debility, soreness and stiffness. 

Restlessness, must change position. 

Great sleepiness, with sleeplessness until 
midnight. 

Dreams of great exertion ; as rowing, swim- 
ming, etc, 

Intolerable itching of the skin, with a red 
rash all over. * 



C L I X I C A L CASES. 137 

Rhus venenata was given, in the thirtieth 
potency. This was chosen in preference to 
rhus toxicodendron because of the profound 
depression of the nervous system, and for the 
reason that this rhus is said to exert a stronger 
influence upon the cuticle ; but I had no ex- 
pectation that it would do anything more than 
reduce the fever and relieve the rheumatoid 
pains. In this I was very happily mistaken, 
for while the pains and the fever abated at 
once, the ecchymoses also ceased to extend, 
began to change color like an old bruise, and 
disappeared within ten days. The nose-bleed 
did not recur after the rhus was taken, the fe- 
ver was all gone by the second day, and the 
wrist and knee supple and free from pain by 
the fourth. The patient was discharged on 
October 26, cured. 

Dr. J. L. Gage, of Vassar, Mich., reports the 
following case in the American Hbmaeopathist, 
November, 1885 : 

2. I remember distinctly a peculiar case I 
had some thirty-five years ago. Was called 
to see a child about a y^ar old. One foot was 
swelled to the ankle and black, a purple or 
black spot as large as a dollar on the opposite 
thigh, and another on side of face. I gave 
rhus tox. 6 ; in three days it was well. 



138 

HAMAMELIS. 

Skin. — 1. An ulcer on inside of lower lip, 
which had been there for a few weeks before 
commencing the proving, assumed a more 
bloody appearance. [Dr. McGeorge ; Trans- 
actions, American Institute of Homoeopathy, 
1874; Mary McC, aged 21 ; took 200th dilution 
once a week.] 

Hcemorrhages. — 1. Nose began to bleed be- 
tween 9 and 10 the next morning, and continued 
for an hour until I smelled camphor ; with the 
epistaxis was a feeling of tightness of the bridge 
of the nose, and considerable crowding pres- 
sure in the forehead between the eyes, with a 
benumbed sensation over the whole os frontis ; 
I was at first somewhat surprised, as in the 
whole course of my juvenile and adult experi- 
ence, I had never before been unfortunate 
enough to get a bloody nose, and epistaxis is 
something I never knew occur in my family. 
[Dr. H. C. Preston; Philadelphia Journal of 
Homoeopathy, vol. 1, page 460 ; from one drop 
doses of the third dilution.] 

2. Profuse epistaxis, checked by smelling 
camphor ; ten hours after first dose. [Ibid. 
A young man took third dilution.] 

3. Bleeding of the nose, which clears her 
head, and affords great relief. [Dr. McGeorge; 



PATHOGENESY. 139 

Transactions American Institute of Homoe- 
opathy, 1874 ; from 200th dilution.] 

4. Gums bleed easily. [Ibid.] 

5. Active uterine haemorrhage, which alarmed 
her very much, but which ceased in a few 
hours after discontinuing the medicine. [A 
young lady took third dilation ; Philadelphia 
Journal of Homoeopathy, vol. 1, page 460.] 

6. She had been flowing considerably for 
twenty-four hours and had lost over a quart of 
blood, bright and fresh, not coagulable, unlike 
her usual catamenial discharge, which was 
dark and coagulated generally ; this happened 
about midway between two menstrual periods ; 
gave sacch. lac, and the haemorrhage ceased in 
a few hours. [Mrs. W. ; proving with third 
dilution. Ibid.] 

1. An alarming haemorrhage from the lungs 
set in suddenly. [A man took Pond's extract 
for several days, for acute rheumatism. [Pr. 
Thomas ; Monthly Homoeopathic Hevicw, vol. 
1, page 251.] 

Concom Hants. — Varicose diathesis. 
Passive haemorrhages. 

Prickling and stinging in the veins, muscles 
and skin. 
Bruised and tired feeling, all over body. 



140 HAMAMELIS. 

Relationship. — Pulsatilla relieved toothache, 
worse in warm room. In purpura. 

Comments. — Hamamelis does not appear to 
have caused purpura. Herpetic and pimply 
eruptions occurred during the provings, but no 
petechia or extravasations. Its curative power 
in this disorder is based entirely upon its action 
upon the capillaries. It is an irritant to these, 
and has caused inflammation in them, extend- 
ing up into the veins ; the result of this is ven- 
ous stasis, haemorrhages, often very severe and 
long lasting, and structural changes. Hama- 
melis does not alter the condition of the blood, 
and if ever useful in true purpura, the symp- 
toms will follow a very different sequence from 
those indicating phosphorus or crotalus. When 
the extravasations are due to disease in the 
vein-walls, and especially in persons inclined 
to varicoses, hamamelis may often prove a po- 
tent remedy. 

Clinical. — The following case was reported 
by Dr. Geo. E. Belcher, in the North Ameri- 
can Journal of Homoeopathy , vol. iii, page. 
463: 

1. A. R. S., a man with a hearty constitution, 
light but florid complexion, and dark auburn 
hair, after complaining some IS or 24 hours, 
was taken on Friday with violent fever. I 



CLINICAL CASES. 141 

first saw him on Sunday, and found the symp- 
toms of a very aggravated type ; pains in the 
back and head very severe, the face deep red, 
and the eyes congested. He was restless, and 
had scarcely slept, and was at times delirious. 
Gave aconite 2, belladonna 2, alternately, every 
two hours.in solution. On Monday his symp- 
toms were generally worse. He had scarcely 
slept at all, and variolous papulae were abundant 
on the whole surface of the face, body and ex- 
tremities, and there was rash between the pim- 
ples resembling measles. Gave rhus 2x, tartar 
emetic, 1, alternately, every three hours. On 
Tuesday evening, about 7, I found that he had 
passed another restless night, but his mind was 
clear, except occasional short wanderings, and 
about noon had epistaxis, which lasted about 
an hour, and again about 5 o'clock P. M., 
which continued after my arrival until about 
8 P. M. The blood was dark, discharging 
freely in drops, the pulse rapid, breathing 
hurried, lips and mouth dry, the face and body 
were covered (beside the papulae, which seemed 
to me not to have progressed, but to have 
shrunken), with a dusty red erythema, with 
purpuric spots, varying from the size of a pin 
to that of a three-cent piece, here and there, but 
over the abdomen, which I more particularly 
examined, occupying one-third of the surface. 



142 HAMAMELIS. 

The vessels of the conjunctiva were so con- 
gested as at first sight to appear like chemo- 
sis. Gave hamamelis, 3 drops of 1st dilution 
in a tumbler of water, of w T hich a tablespoon- 
ful was given every 15 minutes. In 20 minutes 
the haemorrhage had ceased entirely, and re- 
turned no more. The hamamelis was then 
continued every hour. I found on Wednesday 
that he had had one dejection of a dark bloody 
character, but the purpura had not increased, 
and he had slept some. Gave rhus and hama- 
melis, alternately, every hour. On Wednesday 
night he appeared improved ; the mind and 
general feeling were better, the rash and pur- 
pura diminished, and the variola developed 
confluent. By Friday the petechia had dis- 
appeared, and afterwards, under the use of 
tartar emetic, the disease ran its usual course. 

Dr. Okie, of Providence, R. I., reports in 
the Philadelphia Journal of Homoeopathy, 
vol. i, page 538 : 

2. A girl, aged 9, was said to be in a dying- 
state. She was sitting upright, supported with 
pillows, her breath greatly oppressed. She 
had been ill about two years, dating her first 
loss of health to a cough, which was said to 
have resulted from swallowing a small piece of 
straw ; since that period she had been tor- 



CLINICAL CASES. 143 

mented with incessant cough. She bled from 
the lungs pints at a time. She had raised 
large quantities of offensive matter ; at one 
time nearly a tumbler full. Examination 
elicited general anasarca, great swelling of 
lower extremities ; the abdomen swollen from 
the areolar infiltrations ; face much puffed, 
closing the eyelids ; a number of spots, resem- 
bling purpura, were found upon the lower ex- 
tremities ; she had been troubled with profuse 
epistaxis. Ausculatory examination elicited 
the presence of a very large cavitv, extending 
from the mammary region to near the base of 
the right side. The respiration in the left lung 
was puerile, with a mingling of rhonchi and 
mucous rales. The urinary secretion was 
almost nil, the urine itself of a deep, brandy 
color, depositing a heavy lateritious sediment. 
I feared a fatal result, and speedily. The 
scanty urinary secretion and pleuritic pains, 
the hydropic tendency, and the state of the 
thoracic organs led me to fear the supervention 
of anaemia and serous effusion into the pleural 
sac. Iodine was given ; for about a fortnight 
she improved ; the urine was much increased, 
the dropsy lessened, and the respiration easier ; 
petechiae did not appear ; cough about as 
usual. At this time she was seized with haem- 
orrhages, etc., which hamamelis checked 



144 HAMAMELI8. 

promptly and there was no return. The strength, 
appetite and general health improved, so that 
she was up and about her usual avocations. 
She lived about 18 months, but finally died 
from pulmonary abscess. 

Dr. John C. Morgan published the subjoined 
case in the American Journal of Homoeopatltic 
Materia Medica, 1872, page 237. 

3. A babe of nine months had capillary bron- 
chitis severely. When convalescing, it showed 
purplish, evidently hemorrhagic spots, on the 
face, limbs, etc. Regarding it as a capillary 
venous haemorrhage, I gave four doses of hama- 
melis 3, in twenty-four hours ; the first at 12 
M., hoping to prevent the usual afternoon ad* 
dition to the number of spots. Not one ap- 
peared thereafter. 

The following case, reported by Dr. W. C. 
Doane, is from Hoyne's Clinical Therapeu- 
tics, vol. i, page 15 : 

4. There w 7 as oozing of blood from the skin, as 
though it w T as coming from a sponge, and light- 
colored blood was discharged from the mouth, 
bladder, etc. The pulse was 35. Aconite and 
hamamelis w r ere given, and in about a week the 
patient was well. 

From such a report we cannot discover why 
either aconite or hamamelis should have been 



CLINICAL CASES. 145 

given, whether they cured, or whether the case 
simply got well. That aconite may do good in 
purpura is not to be denied. In the febrile 
form of this disorder we may, says Dr. Rich- 
ard Hughes, gain a hint from the experience of 
the dominant school. " The late Dr. Parry, of 
Bath," writes Watson," was the first to point 
out the efficacy of abstinence, venesection, and 
purgations, in some instances, at least, of pur- 
pura. An example of this kind occurred in 
one of Dr. Latham's hospital patients. The 
whole tongue was livid, one-half of it pre- 
senting the appearance of a large, bleeding 
fungus, and on the inner surface of each cheek 
were several black, fungoid patches. The 
patient, also, was voiding unmixed blood from 
the bowels. In this case there was no evidence 
of the operation of any debilitating cause, and 
the pulse, though frequent, was hard. Bleed- 
ing from the arm always gave relief to his 
uneasy sensations ; he was purged also, and 
put upon a low diet. Under this plan he 
steadily improved, and in four or five days no 
vestige of the complaint remained, except the 
fading spots." 

As aconite so completely replaces phlebotomy 
here was its opportunity. That this is not an 
altogether unknown condition is further illus- 



146 HAMAMELIS. 

trated by the subjoined case from the British 
Medical Journal, of October 1, 1859. 

Ellen O'B , set. 29, married, was admitted 

May 25th, 1859. * * * She was quite well 
three days before her admission, and went to 
bed feeling as well as usual. During the early 
part of the night she awoke with a painful sen- 
sation in her legs, as of needles running into 
them ; this continuing, prevented sleep ; and, 
on examining them in the morning, the legs 
were covered with blotches. She dressed, and 
continued at her work for some hours, by 
which time her knees and ankles had become 
red, swollen, and painful, so that she had 
to take to her bed. On the following day, her 
arms had become similarly affected. She suf- 
fered much from thirst and feverishness. 

On admission, her countenance was expres- 
sive of suffering. Pulse 120, full, hard, and 
incompressible. The tongue was coated and 
cracked, but moist. The skin, which was hot 
and dry, presented, on various parts of her 
body (but most of all on the extremities) 
numerous blotches or ecchymoses, varying in 
size from a pin's head to that of a florin. * * 

May 26th. — She did not sleep for pain, and 
was very restless. She had great pain in the 
wrists and ankles. There is a large increase in 
the number of spots, chiefly on the back and 



CLINICAL CASES. 147 

nates. The dorsum of the left foot appears as 
if largely bruised. The tongue is foul ; the 
pulse 120, full, and hard. There is a slight 
tinge of blood in the saliva, streaking it. The 
skin is hot and dry ; chere is no acid smell. 
The countenance is anxious. 

Dr. L. Houghton Kimball, of Boston, fur- 
nishes the following case : 

5. I was sent for on the morning of Tuesday ^ 

June 3, 1884, to see Miss Mabel O , a young 

lady of seventeen. She had retired in her usual 
health the night before, but awakened to find 
her body and the mucous membrane of her lips 
and mouth covered with numerous purple 
spots. She was very hoarse, with a feeling of 
pressure across her chest. There was a dry 
cough from irritation in the throat, and expec- 
toration of large quantities of blood. Put her 
on phosphorus 30. In the afternoon there 
seemed to be more hoarseness and pressure 
with an almost croupy cough for which a few T 
doses of kali bichronicum were given. Soon 
after she commenced passing large quan- 
tities of blood in her urine for which terebin- 
thina 3, was given every two hours. 

Wednesday she continued to cough and ex- 
pectorate large quantities of blood, and to pass 
an apparently enormous amount in her urine. 
Terebinthina was continued. 



148 H A M AM E L I S . 

Thursday showed not much of any change in 
the symptoms, with the exception of a little 
less cough and more rest the night previous. 
Complained of pain in back and across the 
bowels. Terebinthina was continued. 

Friday morning — Vomited considerable blood 
in the night, cough and expectoration of blood 
considerably less. The spots in mouth and 
on lips are healing over. Faints on sitting 
up. Pulse small, weak and frequent. Tere- 
binthina continued. In the afternoon found 
her still passing much blood in urine, although 
the expectoration seemed much better. Bowels 
very sore and tender and distended with gas, 
much pain in back. Pulse 120. Gave hamam- 
elis 3 and terebinthina 3, in alternation every 
hour. 

Saturday morning — Slept very well, mouth 
looks much better, taste natural, no expectora- 
tion of blood. Bowels less tender and less 
tympanitic, pulse 100. Passed no urine from 
seven o'clock last evening till nine o'clock this 
morning. Then it was less in quantity and 
showed less blood. Hamamelis and terebin- 
thina continued, 

Sunday morning — Fainted yesterday when 
attempting to walk from the bed to the lounge. 
Slept well — pulse 100, no expectoration of 



CLINICAL CASES. 149 

blood, a decided lack of urine in the secretions 
of the kidneys for the first time. Same medi- 
cines continued. 

Monday morning — Slept well, pulse 84 — very 
sleepy and weak. No blood in urine or expec- 
toration. My patient now showed a steady 
improvement under the administration of china 
30, and soon regained her usual health. 

TEREBINTHINA. 

Skin.—l. Turpentine causes an eruption of 
the skin similar to that of scarlatina. [J. 
Wharton Begbie, M. D.; Edinburg Medical 
Journal, vol. 17, 1871, page 39.] 

2. A scarlet eruption broke out upon the body 
(after five hours, second day). [Wilmer ; a 
man took the oil for tapeworm, one ounce in 
two doses, within an hour, in the morning, same 
dose in the evening (first day), one and a half 
ounce in emulsion in the space on an hoar (sec- 
ond day)]. 

3. On the third day after some pain during 
the night, the skin of the elbow was found to 
be spotted with circumscribed dark redness of 
the bend of the elbow. On the fourth day, 
there were dark red spots, some of which were 
intensely red. The appearance in general was 
similar to extravasation of blood. [Prof. 



150 TEEEBINTHOA. 

Hopper; N. Zeitung fur Horn. Kron., 7, 177, 
forming by dropping the oil on left elbow.] 

4. In 1818, J. A., a young man set. 22 years, had 
taken, at the recommendation of a layman, one 
teaspoonful of oleum terebinth inse, for a so- 
called rheumatic affection of the hip, which was 
followed by a severe burning sensation in the 
epigastric region, and copious hematuria with 
considerable strangury, and small livid spots 
on the skin of the back and abdomen. [Quoted 
in the American Hornoeopatliist, vol. vii, page 
44 ; original authority not stated. 

Blood. — 1. Turpentine increases the coagu- 
lability of the blood, and gives rise to numer- 
ous minute hepatic and pulmonic thrombi. 
[Leon Crucis ; De la Terebinthina, Paris, 

1847.] 

2. Violent nosebleed. [Hartland and 
Frink's Annals, 3, 118.] 

3. Bloody urine. \_Huf eland) s Journal, 91, 
100 ; effects on the crew of a ship laden with 
Turpentine.] 

4. Expectoration streaked with blood. — 
Trousseau and Pidoux, vol. I, page 563 ; ef- 
fects of one drachm.] 

Concomitants. — Mind clear, then uncon- 



COMMENTS. 151 

scious, followed by inability to concentrate the 
mind. 

Intense pressure and great fullness of the 
head. 

Pulse weak, thready, small, compressible. 

Distressing strangury with great loss of blood. 

The blood is thoroughly mixed with the 
urine. 

Urine scanty and turbid, with epithelial sed- 
iment. 

Copious hemorrhages from various organs. 

The blood is dark for want of oxygen. 

Tongue red, smooth, and glossy ; burning 
like fire. 

Bad effects from living in damp places. 

Comments. — The relations of turpentine to 
purpura are not obvious from its physiological 
effects, and I am not sure of its homoeopathic 
action. In the process of elimination through 
the skin it causes a rash, but this is scarlatin- 
ous rather than purpuric. Its powerful influ- 
ence on the blood, and its ability to induce 
multiple hemorrhages, \ may ally it to some 
forms of the disorder. 

Clinical. — Prof. T. Gr. Comstock, M. D., re- 
ports in the North American Journal of Ho- 
moeopathy, 1861, page 61, the following case 



152 TEREBINTHOA. 

1. On the 24th of November, I860, 1 was called 
to see Frank, aged three years, son of the 
United States Inspector of boilers. Child 
seemed to be covered over a greater portion of 
the body with dark reddish, ecchymosed, or 
purplish-looking spots, which assumed the ap- 
pearance of petechia in clusters. The peculiar 
petechial character of the eruption (if indeed 
purpura may fee called an eruption) was quite 
an anomaly, and the case struck me at once, 
before I had' learned its history, as being of 
unusual interest. The mother informed me 
that the peculiar spots upon the skin had been 
there for several days, and did not alarm her 
because the child was free from any fever ; but 
for the last two or three days he had passed a 
little blood while urinating, and during defe- 
cation, that his nose had bled ; and now blood 
seemed to be coming from the cavity of his 
ears, from his mouth, etc., and that the patient 
was constantly growing weaker. I examined 
the buccal cavity, and found its whole mucous 
membrane studded with spots of the purpura, 
which were well developed, and from which 
drops of blood oozed out. I regarded the case 
as purpura hemorrhagica, and prescribed 
accordingly arsenicum 5, every two hours. 

Nov. 25, 1860. — Patient to-day is worse— the 
haemorrhage having increased in quantity; his 



CLINICAL CASES. 153 

urine seems to be almost pure blood, and forms 
a clot which looks like the substance of an 
enlarged liver. In addition to the haemorrhage 
from different parts of the body externally, as 
well as from the urethra, rectum, cavity of the 
ears, nose, and mouth, he actually bleeds from 
the eyes. Child has scarcely any fever, but his 
pulse is small, fine, and beats 1 20 ; his tongue 
looks dark — nearly black — and coated. On 
account of the delicate constitution of my 
patient, and the very grave character of the dis- 
ease, in addition to the haemorrhage from all the 
mucous membranes of the body, and as the 
quantity of blood passed when he made water, 
and per rectum was enormous, for he seemed 
literally to sweat blood ; 1 pronounced the prog- 
nosis as almost necessarily unfavorable. In 
this dilemma I concluded to try oleum terebin- 
thinae, and accordingly seven drops were ad- 
ministered to him upon a little sugar and 
repeated every three hours. The symptoms 
remained much the same for two days after the 
medicine w^as given ; the haemorrhage was not 
increased, and the second day I fancied that it 
had decreased. The child had very little appe- 
tite, but I gave beef tea and panada with Bor- 
deaux wine, and the same medicine was con- 
tinued until the 29th, when a marked improve- 
ment was manifest, as the haemorrhage had 



154 TE REBOTHOA, 

almost entirely ceased. Without doubt, the 
oleum terebinthinae acted as a specific in arrest- 
ing the haemorrhage. I have met with several 
cases of purpura simplex within the last six 
years, and have treated them all successfully 
with arsenicum and secale ; I have also seen 
in the wards of Oppolzer in Vienna, some very 
interesting cases of purpura haemorrhagica, 
and they always made a great sensation, and 
were carefully observed by a great many medi- 
cal men, other than those attending regularly 
the clinic ; but in no case that I have ever seen, 
where the haemorrhage was so general as the 
above, terminated with a recovery. 

Dr. H. Detwiler, reported the following case, 
in the American Homoeopathist,, vol. VII, Feb- 
ruary, 1881, page 43. 

2. A case of this disease, of a serious nature, 
occurred in the practice of Dr. A. Shough, in 
South Easton, in July last. Its history is as 
follows: Mrs. J. F. S., a widow, aet. 60 years, 
had complained for several days before the 
doctor was called, of lassitude, dimished appe- 
tite, and general malaise, followed by bleeding 
from the mouth and nostrils. The symptoms 
present at his first visit, were paleness of the 
skin; an anxious, alarmed, and confused ex- 
pression of countenance ; bleeding very freely 



CLOICAL CASES. 155 

from the mouth and nose; tongue coated and 
covered with dark blood ; phlyctenae in the 
buccal cavity. Hamamelis 6th, in water, was 
given in teaspoonful doses, every half-hour for 
twelve hours, without effect. An alarming 
prostration of the patient, and an increase of 
the bleeding from the mouth and nose ensued, 
to which was added a discharge of dark, coag- 
ulable blood per anam, and hematuria. A 
consultation was proposed and the reporter of 
the case was sent for. Joint examination 
showed the pulse to be 67 to 70; skin dry, 
tongue thickly coated with sordes and dark 
blood ; blood oozing from its side and 
under surface, as well as \ from the gums 
and the whole epithelial or mucous lining 
of the mouth, palate, tonsils and fauces ; three 
isolated phlyctenae of the size of a large lima 
bean, resembling thrombi, on the right, and one 
on the left, inside of the cheek, which were 
very prominent and from which dark blood 
oozed freely. Blood was passed per anum 
without f cecal admixture ; and the urine con- 
tained black, rather ropy blood, which consti- 
tuted about three-fourths of its entire quantity; 
ecchymotic spots or petechise were very numer- 
ous on the upper and lower extremities, and 
were increasing in number. Phosphorus was 
given, but without effect, as we learned on 



156 TEREBOTHOA. 

visiting her ilie next morning, and all the symp- 
toms had rather increased since our visit on the 
preceding evening. She now had no appetite ; 
extreme prostration ; fainting when raising the 
head ; the pulse was unchanged. Terebinthina 
6th cent., six pellets in a tumbler full of water ; 
of which solution she was to receive a teaspoon- 
ful every half hour until visible improvement 
took place, then every hour or two hours. At 
our next visit we found the patient much better 
in every respect, and she made a speedy 
recovery. The bleeding preceded the appear- 
ance of the ecchymoses on the lower extremi- 
ties. On the hands and forearms they were 
observed on the first visit, and continued to 
increase. 

Prof. E. M. Hale, M. D., sends the following 
observation : 

3. A case of purpura hemorrhagica, in which 
blood appeared in the urine was cured by tere- 
binthina 1 x ; five drops every two hours. 

Erigerok. 

Concomitants. — Epis taxis, and other haem- 
orrhages. 

Dysuria ; urine scanty. 

Comments. — Erigeron is an analogue of sul- 
phuric acid and arnica in extravasations 



CLIISTICAL CASES. 157 

blood into the tissues. Country people use the 
bruised plant in the treatment of contusions 
and bruises ; but whether it is capable of set- 
ling up a condition analogous to purpura, is as 
yet unproven. Like other turpentines, it pro- 
foundly affects the blood, and is well known 
for its anti-hsemorrhagic virtues. Its influence 
upon the kidney will attract attention to this 
remedy when those viscera are involved in the 
hemorrhagic tendency. 

Clinical. — The following case was furnished 
by Prof. J. E. Kippax, M. D. : 

1. Woman : middle-aged ; the principal 
symptoms were marked debility, anorexia, 
headache, sudden appearance of the purpuric 
spots, which first came out on the lower limbs, 
and then extended upward over the whole 
body. These spots were at first of a reddish 
color, but they subsequently became purple, 
and were accompanied by haemorrhage in con- 
siderable quantity from the bladder and uterus, 
often lasting as much as three weeks. This case 
was completely cured by erigeron 3 x. 

Akxica. 

Skin. — 1. Skin red, hot and (Edematous. [Dr. 
Black, British Journal of Homoeopathy, vol. 
ii, page 275.] 



158 AEIICA. 

2. Erysipelatous inflammation, the left hand 
<dark-blue. {British Journal of Homoeopathy, 
vol. iii, page 254.] 

Venous System. — Arnica produces stasis in 
the capillaries, as from a bruise. 

1. Felt as if bruised, over the whole body. 
{Brit. Jour, of Horn., voL vii, page 391.] 

2. Sensations as of being bruised. [Staph; 
Archiv. 5, 3.] 

3. Pain as from a sprain (various parts). 
[Hahnemann ; Materia Medica.] 

4. Multiple haemorrhages ; nose, lungs, etc. 
[Brit. Jour, of Horn., vol. vi, page 267]. 

5. The power of arnica to produce haemor- 
rhages of various kinds, and pains like those 
which attend bruises, is well known ; but I do 
not remember reading or hearing of a case in 
which the drug has produced a black eye, or, 
indeed, any haemorrhage beneath the skin. 
That arnica has a very distinct relation to such 
conditions I had no doubt, and when an oppo- 
nent asked me if arnica had ever produced a 
bruised condition, I was content to reply with 
Hughes * that I was satisfied with Hahnemann's 

* Pharmacodynamics, p. 229. 



pathoCtEIESy, 159 

inference from his provings, that all the symp- 
toms attending violent contusions and tearing 
of the fibres are analogically produced by 
arnica in the healthy organism. But since the 
first of the two cases related below came under 
my observation, I have had a still better an- 
swer to give. The influence of arnica on the 
small bloodvessels, causing them to give way, 
was thus not an analogical inference, but an 
apparent fact. As I looked upon my patient's 
leg, the relation of the drug to a black eye, or 
any other bruise, was strongly impressed on 
my consciousness. There was a very intense 
though localized condition of purpura. I ap- 
pend a second case, where the action bf the 
drug did not reach the same point, for the sake 
of comparison. There was engorgement of 
the vessels, oedema, and much irritation ; but 
though there was a considerable degree of blae- 
ness of the parts, the vessels did not give way. 
The patient in this case was much stronger and 
younger, and the drug was not used to the 
same extent. Both the patients were women — 
who are more frequently affected with purpura 
than men. 

Case I. Mrs. M., 60, fair, of very soft fibre, 
stout, delicate, nervous, sent for me on the 5th 
of Sept., 1882. Seventeen days before she had 



160 A R 1ST I C A. 

slipped down stairs, several steps, bruising her 
left leg. There was much pain and a slight 
bruise appeared on the outer side of the ankle ; 
but the pain was the greater on the anterior 
part of the leg where no bruise was to be seen. 
The skin was not broken. She was treated at 
home ; arnica was applied in various dilutions 
of the mother tincture, and on one occasion it 
was applied undiluted ; these applications were 
rubbed on the limb, which was bandaged, oil- 
silk being placed over the bandage. No arnica 
was given internally. The pain diminished 
greatly, and the treatment was continued twelve 
days. Five days before I saw her, a bright 
redness began to appear on the front of the leg, 
without any pain, heat, or sign of inflamma- 
tion. The arnica was then dispensed with ; but 
tlie next day the redness had increased, and 
small bladders of water began to form. With 
these there was some itching, but still no sign 
of active inflammation. By the advice of 
friends, bell, and rhus were given internally, 
and by the advice of a chemist, calendula cerate 
was applied. On the 5th of September, the 
surface of the limb, instead of being red had 
become black, dotted over with blisters and 
white mattery points. I found the patient lying 
on a couch, dressed, complaining of no pain, 
and with no constitutional disturbance. The 



PATHOGENESY. 161 

tongue was clean, bowels open, appetite fair 
(it was never good), skin cool, pulse 92. She 
was able to walk without pain. The leg was 
swollen, pitting as previous, puffy about the 
ankle : the left leg was normal. There were no 
varicose veins. The lower half of the anterior 
part of the right leg was colored red and black 
with extravasations. There were a few mattery 
points, the size of lentels. Much of the epider- 
mis was raised by clear fluid, and clear fluid 
was oozing from parts where the epidermis was 
broken. The discoloration spread round the 
calf, covering three quarters of the circumfer- 
ence of the leg, but the color was less deep, 
and more scattered behind than in front. 
There was no tenderness. I ordered absolute 
rest, the limb to be kept warm and dry, and 
gave arsenic 3 x. The oozing soon ceased, and 
the vesication disappeared. Then the oedema 
gradually subsided, and the skin became more 
healthy ; sound skin became visible, on this 
part of the leg, which took on a mottled ap- 
pearance. The epidermis all scaled off. The 
recovery was slow, and during the healing 
there was tenderness of the leg, and about the 
ankle. When she had quite recovered, there 
was much brown staining of the skin left be- 
hind. 
The patient had had a good deal of illness in 



162 X K 1ST I C A . 

lier life, and had suffered a little from rheuma- 
tism ; but her previous health did not appear 
to have any important bearing on the illness 
for which I attended her. 

Case II. A lady's maid, about 38, of strong 
physique, and otherwise in very good health at 
the time, consulted me in February, 1885, for 
an affection of the right foot. Three weeks be- 
fore she had sprained her ankle and applied 
arnica lotion across the front of it. An irritable 
eruption appeared for which she consulted me. 
In front of the ankle, from malleolus to. malle- 
olus, was a bright red rash, rather rough, dis- 
appearing on pressure ; no vesicles. There was 
much itching, burning, and when scratched, 
smarting. The itching came on suddenly in 
paroxysms, almost every two hours, and kept her 
awake at night. I gave her rhus internally and 
externally without effect, also calc, apis, and 
bell, lotion. Under sulph. 1 and hamam. lotion 
the rash gradually subsided, but noc before it 
had made considerable progress under previous 
treatment. The rash became purplish in hue, 
and the part affected slightly (Edematous. But 
the vessels did not give way, as the rash always 
yielded to pressure. Even when it began to 
die away under sulph. and ham. it spread at 
the margins, invading the leg and the sole of 
the foot. But here it was less continuous, the 



COMMENTS. 163 

spots were sparse ; but they were very irrita- 
ble. Finally they all disappeared within about 
a fortnight from the time I first saw her. 

The veins of her leg were slightly varicose. 
There was no fever during the course of the 
case. [Dr. John H. Clarke ; American Horace- 
opathist, October, 1885.] 

Concomitants. — The bed on which he lies 
feels too hard ; complains constantly of it, and 
keeps changing from place to place, he feels so 
tired, sore and bruised. 

Typhoidal state. 

Comments. — There is nothing in the skin 
symptoms, except in che interesting cases of 
Dr. Clarke, to indicate purpura, but the great 
value of arnica in suggillatlons has led to its 
use empirically in this disorder, apparently with 
success ; several cases have been reported, but 
the details are not on record. 

Clinical.— See several cases under sulphu- 
ric acid. 

SULPHURIC ACID. 

Skin. — Bluish spots on the forearm, as if 
ecchymosed. [Hahnemann - , Chronic Diseases, 
vol. Y. page 321.] 

Concomitants. — Wants to do everything in a 
hurry. 

Face feels as though the white of an egg had 
been dried on it. 



164 SULPHURIC ACID. 

Extreme weakness and exhaustion, with sen- 
sation of tremor all over the body, without 
trembling. 

Haemorrhages of black blood from all the out- 
lets of the body. 

Acts best on elderly people ; particularly 
women. 

Comments, — Although Allen records one 
hundred and fifteen cases of poisoning by sul- 
phuric acid, very little is known of its action 
upon the skin. Dr. Richard Hughes seems in- 
clined to doubt the homceopathicity of sul- 
phuric acid in purpura, but the subjoined ca- 
ses by Drs. Morgan and Hale (1 and 2) would 
indicate that it really possesses some power. 
Cases 4 and 5 may have been cured by arnica. 
They are given here as part of the history of 
the therapeutics of purpura, and not because 
they are peculiarly instructive. When two or 
three remedies are given at a time, who can tell 
which cured ? 

Clinical. — Dr. John C. Morgan contributed 
the following case to the American Homoeopa- 
thist, August, 1885. 

1. Some time after publishing the case cured 
by hamamelis, in the American Journal of 
HomoeopatMc Materia Medica, 1872, a lady 



CLINICAL CASES. 165 

brought me her son, aged about six years, a 
pale, badly nourished child, with numerous 
hemorrhagic- looking dots over the surface of 
the body, etc. They disappeared within a few 
days, but as fast as they occurred, others 
showed themselves — for some time — despite 
treatment by medicines and improved feeding. 
Naturally, I expected benefit from the admin- 
istration of the previously successful remedy ; 
but it completely failed to improve the case. 
I then studied the whole individual, and gave 
lachesis, but without result. I now recalled 
some successes in scurvy, in my army experi- 
ence in the Valley of the Mississippi, with di- 
lute aromatic sulphuric acid ; >also, the well- 
known anti-Ii*emorrliagic power of sulphuric 
acid ; and on reviewing all the symptoms, com- 
plexion and all, I fixed upon that drug. Four 
doses of the 1600th, (Jenichen), were given 
within twenty-four hours, followed by sac. lac. 
No new spots appeared thereafter, and a few 
days later, all the old ones were gone. 

Prof. E. M. Hale, M. D., furnishes the fol- 
lowing observation : 

2. A mild case of purpura hemorrhagica 
was cured by sulphuric acid, first dilution, 
three drops every two hours, in one week. 

Dr. J. L. Gage, of Vassar, Mich., published 



166 SULPHURIC ACID. 

the following case in the American Homceopa- 
thist, November, 1885 : 

3. A boy about fourteen years old was terri- 
bly burned on his face and neck, hands and 
bare feet by the explosion of a gasoline stove. 
He made a good recovery, but when nearly 
well he had blisters all over his hands, inside 
and out, from the size of a pea to a nickle, 
filled with bloody water. I let out the blood, 
gave sulphuric acid 3, and he soon got well. 

The following case is from the pen of Dr. 
Hale, of Hastings, England : 

4. A gentleman, set. 49, in fair health, with 
the exception of dyspepsia, began to ail in the 
middle of March, 1855. He first had a tender 
and painful swelling over the tibia, with much 
constitutional disturbance. As that got better 
an itching papular eruption appeared over the 
surface. This also disappeared ; but on May 
1st bleeding of the gums, followed by epistaxis, 
occurred ; and Dr. Hale, being summoned, 
found his patient covered with petechia. ' fc The 
concomitant symptoms were of a very grave 
character, an anxious haggard expression of 
countenance, a hoarse voice, a shabby pulse, 
cold perspiration on forehead and extremities, 
and general prostration of the vital powers. 
* * * 'p} ie fi rs t s t e p i n the treatment was to 



CLINICAL CASES. 167 

administer wine freely ; secondly, to give sul- 
phuric acid 2 ; and thirdly, to allow the patient 
to drink freely of orange- juice and water, and 
to support his strength with strong cool beef- 
tea and jelly. 

Improvement ensued, but the next day blood 
began to pass in the urine in large quantity. 
On the eighth day, however, all haemorrhage 
had ceased : and the patient made a rapid con- 
valescence. Besides the sulphuric acid, ledum 
3, and arnica 3 were given. 

The next case is by Mr. Williams, of Liver- 
pool, and is so brief and instructive that I give 
it entire (vol. xvii, p. 288) : 

5. On the 19 th of January, 1859, I was called 
to see a man of spare habit of body, aet. 50, 
complaining of pains in knees and elbows and 
wrists. Headache, shiverings, very thirsty, 
tongue very much coated, bowels were open. 
There was no swelling of the joints ; the pulse 
was 100, full. Ordered belladonna 2. 

On the 20th, the painful joints became swol- 
len, very much headache, pulse 130. eyes wat- 
ery and lids swollen, black patches about the 
size of a sixpence appeared on and over eyelids 
and on nose, tongue was much swollen, and a 
great quantity of saliva flowed from mouth. 
The shiverings continued, urine was scanty and 



168 SULPHURIC ACID. 

high- colored. Ordered acid, sulph. 1, and ar- 
nica 1, alternately. 

Next day, purple patches appeared on 
thighs and legs, much larger than those on 
face. There was a greater discharge from the 
mouth. The tongue was covered with a black 
kind of mucus. The tonsils were much swol- 
len and ulcerated, gums exceedingly tender, 
and the fetor from the mouth was most offen- 
sive. Pulse 130 and weak. With difficulty he 
could speak, and was quite unable to swallow 
anything solid, even the medicine caused great 
pain in deglutition. During the night there was 
great restlessness and slight delirium. Continue 
the acid, sulph. and arnica. The day follow- 
ing the breath was so offensive that with diffi- 
culty I could stay in the room. His wife was 
quite unable to bear it ! The other symptoms 
remained the same and the pulse was if any- 
thing weaker. I ordered some chloride of lime 
to be placed in the room, otherwise no one 
would enter it to attend him. I also prescribed 
a lotion for the mouth, containing : j of tr. ar 
nica, to I viij of water, to be used frequently 
during the day ; and continued the acid, sulph. 
and arnica. Next day the fetor was decidedly 
less. No fresh patches appeared. He had 
rather a better night though the delirium con- 
tinued ; he complained of no pain anywhere, 



clinical cases. 169 

only in swallowing. The knees and wrists 
were not much swollen, urine was more natural, 
pulse 120, weak. For three or four clays no 
fresh symptoms arose, but the patient was evi- 
dently sinking. Beef-tea and milk were ad- 
ministered when he could take it ; also he got 
wine daily, and continued the acid, sulph. and 
arnica. 

On the 29th the symptoms presented a more 
favorable character, the fetor had entirely gone 
from the mouth and the discharge was much 
less. He could swallow better, had some sleep 
during the night, ft.lt stronger ; pulse 100, not 
so weak ; the patches began to disappear from 
the nose and eyes and the swelling to leave the 
face ; he could speak better. Next day there 
was a still greater improvement. He felt hun- 
gry, and had no pain on deglutition ; all the 
patches were nearly gone from the face ; those 
on the arms and legs were much less : he con- 
tinued to improve daily. The patches left the 
legs and thighs, except one that sloughed, 
which healed under cold water dressing, and 
on the 24th February I pronounced him well. 
The acid, sulph. and arnica were stopped for 
the last few days. 

BRYONIA. 

Skin. — 1. Round, red spots, as large as peas 
and larger, in the skin of the arm, without sen- 



1 70 BRYONIA. 

sation ; they do not disappear by pressing up- 
on them. [Hahnemann, from Materia Medica, 
symptom 411.] 

Concomitants. — Exceedingly irritable ; in- 
clined to be angry. 

Yery morose ; needlessly anxious. 

Vivid or frightful dreams ; about business or 
household affairs. 

Stitching or tearing pains ; in various parts of 
the body ; aggravated by the least motion ; the 
fear of pain keeps the patient from moving. 

Sitting up in bed causes nausea and fainting. 
Nosebleed and other haemorrhages. 

Clinical. — Dr. John L. Seward, of Orange, 
JN". J., published the following case in the 
American Hom&opatfiist, October, 1885. 

1. This patient was an infant, at this time 
about ten months old, who had always been 
sickly. The mother's father was scrofulous 
and asthmatic, and all of his children were del- 
icate. When I saw this child it was covered 
with hsemorrhagic patches. Its entire left side 
and back was one solid mass of extravasation. 
The right thigh looked as if the child had been 
thrown on the floor and kicked. I gave arsenic, 
phosphorus, and china, successively, but with- 



CLINICAL CASES. 171 

out result. One day I noticed that the child 
appeared to feel worse on being lifted up, and 
acting upon this hint I gave bryonia 200. The 
child improved greatly in every way. The pur- 
puric spots entirely disappeared. The child 
died the following summer of diarrhoea, but it 
at no time had a return of the purpura. 

Dr. Elias C. Price, of Baltimore, writes to 
me as follows : 

2. During the early part of the year 1874, a 
lady came to see me from Prince Georges 
County, Maryland. She was about fifty years 
old, perhaps more. Her mouth and gums were 
bleeding very profusely ; and on looking into 
her mouth I found a number of purple blood- 
blisters on the gums and buccal cavity. I gave 
her bryonia. In a few hours the bleeding was 
arrested. I think she only remained in the city 
about twenty-four hours ; she took bryonia 
home with her, and in a few days reported her- 
self as quite well. In 1876, two years subse- 
quent to this attack, during the Centennial ex- 
hibition, she went to Philadelphia, and in part- 
nership with another lady opened a boarding 
house. I do not think it was more than six or 
eight months after going to Philadelphia to 
live, when she had another attack of purpura 
hemorrhagica, of which she died. 



172 CHLORAL. 

3. I have had several mild cases since which 
have yielded very readily to bryonia. 

CHLORAL. 

Chloral affects profoundly the nutrition of 
the skin, and produces various forms of lesion, 
accompanied by fever and tenderness, and suc- 
ceeded by desquamation. The chloral-rash, 
follows by preference the course of the larger 
nerve-trunks, and remains latent until aroused 
by some stimulus to the vascular system ; but 
then appears with an intensity and rapidity 
which are proportioned to the exciting current 
of the chloralization (Schule). Most usually 
the eruption is a smooth, bright scarlet erysipe- 
las, or a dark erythematous flush ; sometimes 
it resembles nettle-rash, and at others, measles ; 
and as a rule it is accompanied by severe itch- 
ing. This hypersemic condition is extraordi- 
nary intensified immediately after the inges- 
tion of the smallest quantity of wine, beer, or 
spirits (Murphy.) The drug has not often been 
pushed beyond the stage of intense erythema, 
with multiple cedemse, the minute cutaneous 
blood-vessels being visibly dilated ; but in a 
few cases conditions, evidently purpuric in 
nature, have been noted, and the ultimate 
action of the drug in this direction has thus 
been shown. 



PATHOGEXESI. 173 

1. The pernicious effects which chloral may, 
under certain conditions, exert, do not seem to 
be limited to vaso-motor paralysis, or a tran- 
sient skin neurosis. Two cases which have oc- 
curred have seemed to demonstrate that they 
inay also involve the constitution of the blood 
and the nutrition of the tissues, and may thus 
imperil life. In these two cases, chloral ad- 
ministered in the presence of organic disease 
of the brain, induced what can only be desig- 
nated acute purpura — a condition in which, 
with marked constitutional disturbance, there 
was alteration in the capillaries of the cuta- 
neous and mucous surfaces, with sub-cuticular 
haemorrhage and ecchymoses. 

M. A., female, set. 69, who had been an in- 
mate of this asylum for many years, and who 
was subject to periodical attacks of mania, oc- 
curring every six months, and ushered in by 
convulsions and coma, entered upon one of her 
wonted paroxysms on the 1st of March, 1870, 
and was ordered twenty grains of chloral hy- 
drate three times a day. This produced sleep 
and cutaneous anaesthesia, and on the 4th of 
March a very unexpected result, in the form of 
a bright red blush, erythematous in aspect, but 
permanent under pressure, over the chest and 
shoulders. This blush, on March 6th, had 
pervaded the whole of the trunk and 



174 CHLORAL. 

limbs, and had become mottled with livid 
patches and deep red spots. The lips and 
buccal mucous membrane had contempora- 
neously become red and raw-looking, the gums 
spongy, and the tongue blistered and ulcerated 
in several parts. The breath was foetid, the 
pulse 120, feeble and compressible, and the 
general condition that of great debility, with 
delirious excitement. On March 9 th no ma- 
terial change had taken place, except that the 
ulceration in the mouth had become more ex- 
tensive and distressing ; but onjihe 11th the 
petechial eruption showed signs of vanishing 
over the thorax and abdomen, where it had 
never been so severe as on the arms and legs, 
and where intervals of yellowish and white 
skin were now visible. The arms were of a 
red color, speckled with shreds of white, dead 
epidermis, partially separated from the sub- 
jacent cutis, and the lips were covered with 
sordes and dried blood. On March 15th a sort 
of general desquamation had set in, the cutis 
being raised in thick, round patches, like 
blisters from which the serum had been ab- 
sorbed, the skin beneath being of a dull purple 
color, and in some places yellow. After this a 
large bed-sore formed over the sacrum, and 
some superficial cracks and fissures presented 
themselves in the neighborhood of the joints. 



P A T H O G E X E S Y . 175 

Convalescence was however, steadily main- 
tained, and the patient was soon restored to 
her usual health. During the progress of this 
case, from my narrative of which many interest- 
ing particulars have been necessarily omitted, 
I had an opportunity of showing it to my friend, 
Mr. Pridgin Teale, who, without any hint from 
me, at once pronounced it an example of pur- 
pura. 

2. The second case to which I have referred 
was that of L. T., a female, aet. 46, laboring 
under heart disease, left hemiplegia, and de- 
mentia, with excitement ; who was ordered, as 
a calmative, on February 24th, 1870, fifteen 
grains of chloral thrice daily, and who seemed to 
derive benefit from the prescription until March 
15th, when numerous reddish-purple blotches 
were observed around the left elbow, which, on 
the following day had enlarged and united with 
others of a similar kind which had come out on 
the shoulders and forearm. On March 17th, 
several livid marks had broken out on the face, 
while the left arm had become swollen and in- 
durated, and showed upon its red surface a 
mass of minute points, or stigmata, of a much 
deeper red, and not disappearing under press- 
ure. On the next day, dull-purple spots and 
discolorations — some small, round, and circum- 
scribed, others large and regular in shape— 



176 CHLORAL. 

where seen on the leg, abdomen and back ; 
being restricted, in the latter situation, to a 
band two inches in breadth along each side of 
the vertebral column. Along with these pete- 
chia there was great prostration of strength, a 
tendency to somnolence, weakness and irrita- 
bility of the pulse, a raw state of the lips, 
which were entirely denuded of epithelium, 
and a fissured and thickly coated tongue. 
On the 19th of March, the spots and discolora- 
tions had spread in every direction, and had 
lost their vividness of hue, having assumed a 
deep purple tinge. Symptoms of pulmonary 
congestion also appeared. Strength gradually 
ebbed ; and after several slight attacks of 
syncope, death took place on the 22d of March. 
At the autopsy, thirty-one hours after death, 
the body was found covered with livid vibices 
and ecchymoses of various shapes and sizes, 
largest upon the limbs, smallest upon the 
abdomen. The ankles and feet were of a dif- 
fused purple color, and there was much sugilla- 
tion of dependent parts. Rigor mortis was 
present. The outer layer of the pericardium was 
adherent to the heart, which weighed seventeen 
ounces, had thin walls, dilated cavities filled 
with decolorized clots, and valves incompetent, 
and enormously thickened and puckered. 
There was a sort of cartilaginous deposit on the 



COMMENTS. 177 

outside of the right auricle. The right lung 
was congested and oedernatous ; the liver was 
fatty; the capsule of the kidneys were thick- 
ened and adherent, with wasting of the cortical 
substance. In the head a large arachnoid cyst 
was found, coextensive with the right hemi- 
sphere, which was flattened beneath it. It 
presented a reddish-green appearance, and con- 
tained several ounces bilio-sanguiaous looking 
fluid. The whole brain weighed forty ounces ; 
the right half weighed eighteen ounces, the left 
half twenty-one and a half ounces. There were 
the rusty-brown traces of an old clot in the 
right corpus striatum. [Dr. Crichton Browne, in 
a paper entitled Chloral Hydrate : its Inconven- 
iences and Dangers, London Lancet, April, 
1871.] 

Comments. — In case it might be said that 
such cases of purpura would not likely be pro- 
duced in persons who had no brain affection be- 
forehand, it is important to quote Dr. Browne's 
remarks on these interesting cases. He says : 
No question can, I conceive, arise that in the 
cases just described the purpuric affection was 
due to the use of chloral. The symptoms 
which they presented were of an unique kind, 
and almost unparalleled- in asylum practice at 
the present day. Purpura senilis is occasion- 
ally encountered in aged insane women, affect- 



178 CHLORAL. 

ing chiefly the dorsal aspects of the hands and 
arms ; but purpura of the type exhibited in the 
above cases is, as far as I know, never met with. 
The modus operandi of chloral, in inducing this 
type of purpura, can only be conjectured. It 
may have been that a blood change was the 
first step in leading to the lesions observed. It 
Is not improbable, however, that some altera- . 
tions or withdrawal of nervous influence, inter- 
fering with the elasticity and calibre of the ves- 
sels, may also have been concerned. Whatever 
the action of chloral on the blood may be, it 
seems scarcely of a protective or salutary kind, 
as the two worst instances of typhoid fever in 
this asylum, during last year, occurred in 
women who had been taking chloral for some 
weeks before they w T ere struck down by that 
malady." 

Dr. Dyce Brown commenting on these cases 
in the Monthly Homoeopathic Review, June, 
1871, says : These two cases are, to homoeopa- 
ttiists, extremely valuable, as no remedy we 
have has produced such unmistakable exam- 
ples of purpura. The medicines, hitherto 
known, producing the effects most resembling 
purpura, are mercurius, arsenicum, and phos- 
phorus ; but the latter, as Dr. Richard Hughes 
observes in his Manual of Therapeutics, 
does not seem to produce purpura symp_ 



CONCOMITANTS. 179 

toms as a primary effect, but only in connection 
with the morbid state of the liver induced by 
phosphorus. Not so chloral. Its effects are, 
therefore, the closest simile possible to pur- 
pura, and point it out as likely to be of great 
service in the treatment of this disease. 

Concomitants — There has been no clinical 
experience with chloral in purpura as far as I 
am aware ; but cases with the following con- 
comitants seem tentatively to be indicative for 
its use : 

The mental phenomenon of delirium tremens, 
when not caused by alcohol. 

Confusion of thought,, cannot keep the mind 
to one idea. 

Eyes bloodshot and constantly watering. 

Dimness of sight ; transitory blindness ; dip- 
lopia ; or, photophobia. 

Eyelids droop. 

Face haggard ; or, intensely suffused with 
a deep redness. 

Gums spongy. 

Partial paralysis of the organs of deglutition 
and speech. 

Gelatinous diarrhoeic stools. 

Unconscious urination. 

Dyspnoea ; expiration easier than inspira- 
011 . 



180 IODU3I. 

Venous hum in the neck. 

Profound cutaneous anaesthesia. 

Indisposition and incapacity for muscular 
exertion. 

Utter prostration of muscular strength. . 

Lower limbs very weak, with sheer inability 
to put one leg before the other. 

Frightfully severe pains, particularly about 
the joints, worse in moist and cold weather ; 
the pains very strictly resemble the analogous 
sufferings which are (somewhat rarely) pro- 
duced by chronic alcoholism ; they do not run 
in the course of the nerves like neuralgia, nor 
are they exactly in the joints, like articular 
rheumatism ; they seem to encircle the limb, 
the finger, etc., immediately above or below a 
joint. [Observation by Anstie ; verified by G. 
W. W. in a case of chloral inebriism.~] 

Aggravation of the symptoms from even the 
smallest quantity of alcoholic beverages. 

IODUM. 

Skin. — 1. Various species of eruptions, from 
simple erythema to morbus maculosus (pur- 
pura). [Rilliet; Memoir Sur VIodisme, Paris, 
I860, General Effects.] 

2. Ecchymosis or purpura on the lower ex- 
tremities. [Stille ; Therapeutics, I, 731.] 



COMMENTS. 181 

Concomitants. — Emaciation. 
Ravenous hunger. 
Hoarseness. 

Comments. — Iodine has 'a -powerful influence 
upon the blood, and when its use is long-contin- 
ued the blood and all the secretions become 
thin and watery. 

KALI HYDRIODICU3I. 

Skin. — 1. Purpura. [Dr. Flagg, Charles- 
ton Medical Journal, 1848 ; Effects.] 

2. Purpura, in a predisposed subject, and of 
course erythema and other symptoms of 
iodism. [Tilbury Pox ; Lancet, 1867, vol. I, 
page 455 ; General Effects.] 

3. I have seen it produce on three several oc- 
casions, after a fortnight's use, a genuine spot- 
ted disease on the legs of a gentleman ; in the 
oase of a lady, I ordered it for removal of a 
very serious tertiary symptoms of syphilis ; it 
caused toward the termination of the cure a 
petechial eruption on the lower limbs. [Ric- 
ord, Bulletin cle Therapie, Sept., 1843 ; Char- 
acteristic effects in Syphilitic patients.] 

4. Phlegmonous swellings, as from bruises. 
[Houat ; Pathogenesis nouvelles Donniees de 
Materia Medica.~\ 



182 KALI II Y D It I O D I C U M . 

5. Eruption on the face (alter some days) ; sub- 
sequently all over the body ; maculae first of a 
dark-red color came out, which gradually got 
darker, until the spots resembled purpura ; the 
cuticle next became raised over some of the 
spots, and was filled with a fluid of a purple 
color, constituting large bullae an inch in diam- 
eter. [Dr. O'Reilly; New York Medical Ga- 
zette, quoted in New York Journal of Medi- 
cine, 1854, page 297.] 

6. He presented a most grotesque appear- 
ance, looking more like a leopard than a man ; 
he was mottled all over with spots ; those on 
his face were purple, whilst those on the lower 
extremities were of a dark-red color ; the spots 
on the legs came out last ; there were two large 
bullae on the forehead, one on the lip, two 
under the left clavicle, two on the inside of the 
right thigh, one on the side of the prepuce. 
Mortification seized on the lip ; the patient 
emitted a most vile smell; his mind was inco- 
herent ; and vital powers were prostrated to 
the lowest degree. The patient rallied, the 
eruption disappeared, and the patient recovered 
excellent health, but with the loss of the entire 
penis. [Ibid; another case ] 

7. N. F., age 28, Irish, entered Ward 10, 



PAT II OGENESY, 183 

Charity Hospital, December 21, 1870. His 
venereal history, as given by himself was im- 
perfect. He acknowledged ; having had gonor- 
rhoea eight years ago, and again six years ago,, 
but denied having had any sores upon the 
genitals, or any of the ordinary early secondary 
symptoms of syphilis. Last February, eefchy- 
matous ulcerations made their appearance upon 
the legs, and it was for these that he sought 
admission to the hospital. On December 23, a 
mixture containing twenty grains of iodide of 
potassium was given him. On the evening of 
the following day, after having taken only 
three doses, the patient complained of heat, 
and a burning sensation in his face and hands, 
which were observed to be reddened, and the 
medicine was at once discontinued. On the 
next day, he had small purpuric spots thickly 
covering his feet and the lower portion of the 
legs ; with this were bullae, tilled with purplish 
fluid, situated on the back of the neck, the 
face, and upon the hands. In evidence of the 
fact that this eruption was produced by the 
iodide of potassium, the patient reported that 
on three previous occasions he had taken 
iodide, and always with the same unpleasant 
results. Prof. B. W. McOeedy, has since told 
me of a similar case in his practice; and Boinet. 
(Iodotherapie, 1865, page 68), states that 



184 KALI HYDEIODICUM. 

Cazenave has seen "eruptions of bullae filled 
with sero-sanguinolent fluid" under similar 
circumstances. [Prof. Freeman J. Bumstead, 
M. D.; American Journal of the Medical 
Sciences, vol. lxii, 1871, page 99.] 

8. Virchow has observed the iodide of pot- 
assium cause purpura hemorrhagica, when 
administered to a patient with cancer. 

Concomitants. — Scrofulous and syphilitic 
affections. 

Enlarged or atrophied glands. 
(Edematous infiltration of tissues. 
Coryza, with pain in the frontal sinuses. 
Swelling and sponginess of the gums, with 
ptyalism and fetor of the breath. 

Comments. — The influence of the iodide of 
potassium upon the blood cannot be said to be 
definitely determined ; but it is known to re- 
duce the vital constituents of that fluid, and its 
power to produce petechia and ecchymoses is 
now conceded by all authorities. Iodine and 
the iodide of potassium are very similar in 
their effects upon the blood and skin ; and in- 
deed so nearly are they identical that many 
excellent practitioners fail to differentiate 
between them. 



185 

MERCTJRIUS. 

Alley, of Dublin, has described a spotted dis- 
ease of the skin, caused by the use of mercurials, 
consisting of purplish blotches, and resemb- 
ling purpura. Dr. Richard Hughes says that 
mercurius unquestionably causes ecchymoses 
and haemorrhage, through its action upon the 
blood, and in the asthenic febrile form of 
purpura, when the consecutive symptoms 
indicate that the blood is at fault, he prefers 
it to any other medicine. Its destructive in- 
fluence upon the blood is fully recognized 
by all observers ; its effects are thus stated 
by Dr. Headland: "By some inscrutable 
chemical power, of whose agency we know 
nothing, it is able to decompose the blood: by 
some destructive agency, it deprives it of one- 
third of its fibrin, one-seventh of its albumin, 
one third or more of its globules ; and at the 
same time loads it with a fatty, fetid matter, 
the product of decomposition." In the same 
strain Bartholow observes : " It remains true 
that any considerable quantity of mercury, ad- 
ministered a sufficient time, will affect the 
quality and composition of the blood ; the red 
globules are diminished in number ; the fibrine 
loses its plasticity ; the proportion of water is 
increased, and various effete materials, whose 
nature is unknown, accumulate/' Stille re- 



186 MEKCURIUS. 

cites the elements of an artificial land-scurvy 
set up pathogenetically by a profuse and 
prolonged use of mercurials: "The muscles 
lose their firmness, fullness, and power ; the 
complexion assumes a pallid or an earthy hue ; 
the breath becomes fetid ; the urine is readily 
decomposed ; and diarrhoea is usually present. 
The gums grow spongy; the hair falls out; dull 
pains in the bones and joints are felt ; oedema 
of the ankles, or even general dropsy, may 
form ; haemorrhage from the nose, bowels, kid- 
neys, or reopened wounds, takes place ; and 
hectic fever, with tubercular consumption, may 
terminate life." All this reads much more like 
scurvy than purpura, and I very much doubt 
if mercury ever takes high rank in the ordi- 
nary forms of this disease. In anomalous 
cases, however, it may prove the true siviilia ) 
and become the only drug capable of saving 
the life of the patient. 

Whether the subjoined case, furnished by 
Dr. Buchmann, of Alvensleben^roves anything 
as to the purpura producing power of corrosive 
sublimate, or whether the ecchymoses were due 
to iodoform, I will not venture an opinion ; but 
give the case a place here as an interesting 
study in pathognomonic effects, as reported by 
a capable and discriminating practitioner. 



PATHOGEIESY. 187 

March 4, 1885. A. Fr., 4f years, girl, com- 
plained of pains in the left meatus and externus 
which increased to the 7th, and resulted in loss 
of consciousness. The physician called diag- 
nosticated scarlatina, and ordered wrapping 
the child in cold sheets. Besides 

R. Acid muriat. 1:160 internally. 

March 9. Ill-smelling, purulent discharge 
from both ears. 

March 16. The abcess was opened above the 
left mastoid process. Deafness. 

R. Solut, sublim. 5,0 in alcohol 40,0 D. S. 
poison, to use with 5 liters of water. One liter 
daily was used for injection into the opening 
of the abcess, and into the ears. % A part of the 
solution went through the Eustachian tube 
into the throat and was swallowed. After each 
injection iodoform was blown in by a rubber 
tube, though an allopathic journal had warned 
against the simultaneous application of iodo- 
form and corrosive sublimate. 

March 25. R. Chinin. mur. 0,1 with one 
drop of acid mur. in a wafer, for the bleeding 
from the abcess opening, was vomited up again, 
and no more given. 

March 26. Ecchymoses and petechia first on 
the legs, then all over the skin of the body, 
except in the face. Sponginess of the gums, 
bloodv mucus in the mouth. 



188 MERCURIUS. 

March 27. Blood urine. An allopathic 
physician, called in on the 28th, in the morn- 
ing declared the case incurable, but neverthe- 
less, ordered liq. ferr. sesquichlor; which was 
not given, however, as the child would not 
take it, 

March 28. Afternoon. I was called in. The 
smell of iodoform, which to me is intolerable, 
caused me to remove the child from the sick- 
chamber into another room. Status prsesens: 
frightful, pale, gray face, lusterless eyes, dys- 
pnoea, pulse hardly perceptible and uncountable. 
Deafness. Sleeplessness. Stinking, black, 
tough mucus in the ears ; black, tough mucus 
in the mouth ;. black, coagulated blood evacu- 
ated from the bladder. (Edema of the lower 
extremities. Skin like as if it were sown over 
with ecchymoses and petechia, except on the 
face. The child moves no limb, not even the 
eyes, and has taken no food, but water to-day. 
No sleep at night, and constant moaning. 
Gave arsenicum 30, every three hours. 

March 29, A. M. The child is reported to 
have slept some, to have taken milk, to have 
less dyspnoea. From the beginning I was of the 
opinion that a cure might be possible only in 
oneway, viz., if it would succeed, by the greater 
affinity of a high potency of similar action to 
the morbific cause, to drive this out, and I 



PATHOG.ENESY-. 189 

thought mercurius viv. to be adequate for that 
purpose, but I did not have it at hand when 
needed. I, therefore, now sent three globules 
of mercurius vivus cm. Fincke, in a paper with 
sugar of milk, to be diluted in a cup of water, 
and one teaspoonful to be taken every two 
hours. 

March 30, 2 P. M. When I called they told 
me that last night, at 8 o'clock, such a strong 
odor of iodoform Issued from the mouth, nose 
and ears of patient, that the whole room was 
filled with it, and they had to open the windows 
in order to enable me to stay in the room. This 
odor disappeared as suddenly as it came at 5 
o'clock this morning, after it had lasted all 
night. The child has taken more milk. Pulse 
120. Dyspnoea gone. Stinking, blackish, 
brown secretion from the ear. No blood in the 
mouth. Gave nitric acid 200 (Lehrmann) every 
third hour. 

April 1. — Mouth without blood. Urine 
straw-colored, perfectly transparent. Petechise 
and ecchymoses pale. The child can speak 
again, and looks much better. Desire for beer. 
Continued the nitric acid, as before. 

April 3. — Profuse epistaxis. Tamponaded 
with cotton, moistened with liq. ferr. sesqui- 
chlor., and gave china 30, every third hour. 

April 4. — Great debility ; continued china as 
before. 



190 MEECtJRITJS. 

Aprils. — Petechia and eccliymoses and oedema 
have all disappeared. Increased suppuration 
from the ears : ill-smelling, but not bloody. 
Gave one dose of silicea, in the evening. 

April 12 — She can stand on her feet. At noon 
she eat soup, for breakfast took white bread, 
and for supper the same with milk. 

April 15. — Suppuration from the right ear 
only. The abcess-opening not quite cicatrized. 
Patient can walk again. Gave Pulsatilla 6, 
three times a day. 

April 22. — Abcess forming behind right ear ; 
on opening it a profuse purulent discharge. 
Gave one dose of aurum 30, in the evening. 

May 2 — The discharge from the abcess be- 
hind the right ear has ceased ; hearing pretty 
good. Otherwise perfectly well. [Translated 
from the AllgemeineHom.Zeltung^vol.llO^age 
180, by Bernhardt Fincke, M. D. ? Brooklyn, 
New York, and reproduced here from the 
American HomoeopatMst, vol. XI, page 285.] 

erPRinr acetioum. 

Skin.— Petechial spots on neck and arms. 
[Journ. de Councils, 1843 ; a woman poisoned 
by verdigris.] 

Concomitants. — Irritability with indifference; 
weeps much ; constant restlessness, as if some 
misfortune was impending. 



CONCOMITANTS. 191 

Nervous trembling, with restlessness. 

Cramps in the legs and feet, with great rest- 
lessness ; extensor muscles most prominently 
effected. 

Chilliness over the entire body ; most severe 
in the extremities. 

Great muscular weakness. 

Gums ulcerated ; mouth dry. 

Thirst for cooling drinks, which relieve the 
gastro-intestinal symptoms. 

Menses suppressed, with violent, unbearable 
cramps. 

Dyspnoea, as from inhaling acrid vapors. 

Paralysis of muscles of the back ; of the 
limbs ; without loss of sensibility. 

Comments. — Copper produces vaso -motor 
paralysis, and, therefore, moves in the same 
plane as does the influence, whatever it may 
be, that causes purpura abruptly in persons 
apparently in the enjoyment of perfect physi- 
cal health. It has, as far as I am aware, no in- 
fluence upon the blood, and cannot, therefore, 
benefit cases that depend upon, or are compli- 
cated with, changes in that vital fluid ; but 
there are doubtless many cases which are pure- 
ly neurotic in origin — and neuroses as a cause 
of skin diseases are assuming more and more 
importance in dermatology as the pathology of 
these disorders is more accurately evolved from 



192 C U P R II M . 

the obscurity which has always enveloped it — 
and in such, cuprum, when indicated by the 
concomitant conditions, may yet achieve dis- 
tinction, and prove indeed a friend in need. 

Clinical. — The following case, reported by 
Dr. Kissel, is from Hoyne's Clinical Thera- 
peutics, vol. ii, page 237 : 

1. A girl, seven and a half years old, blonde 
complexion. She had been for eight days 
sown ''broadcast" with dark red spots, from 
the size of a millet-seed to a shilling. These 
spots Occupied the upper half of the body, the 
chest, upper arms, face, and mucous mem- 
brane of the mouth. Otherwise her health 
seemed undisturbed. Urine normal. The 
number of spots increased ; on the fore- 
head, both eyelids, and elbows, bluish ecchy- 
moses of the circumference and height of a 
half walnut arose. From one alveolar process 
from which the child had herself extracted 
an incisor tooth two days before, blood con- 
tinually flowed ; her cheeks and lips were pale ; 
strength gone. Staller's acid stopped the tri- 
fling alveolar haemorrhage, but by no means 
proved a true remedy for the disease. For, 
after eight days, a boil of the size of half a 
moderate apple developed itself on each shin- 
bone. The cuprum aceticum at once arrested 
the progress of the disease and cured her. 



193 

SAXGUIXAEIA. 

If there was anything in the doctrine of sig- 
natures, and who will venture to say that there 
is not the basis of a genuine therapeutic idea, 
blood-root should certainly be a precious rem- 
edy in purpura. In the slow evolution of 
therapeutic knowledge, sanguinaria has not yet 
achieved any special distinction in this line ; 
but, there are several reasons for suspecting 
that it will yet be acknowledged as a valuable 
remedy in ecchymoses, the most important of 
which is that, in one well-attested case, it has 
caused them. Beside this, sanguinaria has a 
well-known influence in causing paralysis of the 
entire vaso-motor system : and as has been 
pointed out. on previous pages, vaso-motor de- 
bility is the inciting, if not the veritable, 
cause of some of the cases of purpura. Again, 
sanguinaria affects all the mucous tissues pro- 
foundly, and while a more thorough study of 
the drug may not show the same degree of le- 
sion produced on the cutaneous as on mucous 
surfaces, yet we know that all remedies that 
effect one influence the other. It may, there- 
fore, be safely stated that sanguinaria is a drug 
which we cannot afford to lose sight of in the 
discussion of the therapeutics of this disorder. 
The following very instructive case was re- 
ported by Dr. William M. Decker, of Kings. 



194 SANGUINARIA. 

ton, New York, at the semi-annual meeting of 
the New York State Homoeopathic Medical 
Society, at Ithaca, in September, 1883, and is 
published in volume xix of the Transactions, 
from which it is quoted : 

The subject of this disease was the second 
child of good parentage ; a male, aged three 
years. Temperament, leuco-phlegmatic. Head 
and frame large and well-proportioned. Tissue 
largely adipose ; muscles flabby. Complexion 
blonde. Mentally bright, with a jolly, good- 
natured, playful disposition. The child has an 
asthmatic or catarrhal diathesis, and easily 
catches cold; but, excepting an occasional attack 
of asthma, and repeated coryza and mild laryn- 
gitis, had been usually well up to the time of 
this sickness. His appetite was good, and he 
was very fond of cow's milk, upon which he 
mainly subsisted. He drank the milk cold ; 
and soon after drinking it, the surface of his 
body would be cool, his face, and especially hi§ 
ears, pale, cold, and anaemic. This condition, 
and his susceptibility to catching cold, are sug- 
gestive of a lack of vital force. For a short 
time previous to the manifestations of the dis- 
ease he drank milk from cows, which were fed 
cotton-seed meal for the purpose of increasing 
the quantity of their milk ; but this, I believe, 
had no influence upon the disease. Just pre- 



PATHOGENESY. 195 

ceding the disease he either had catarrhal 
laryngitis or asthma, for which an old school 
physician administered sanguinaria canadensis, 
and by mistake gave an overdose, which 
produced intense nausea, emesis, and consider- 
able prostration. The following day there ap- 
peared, just under the skin, blotches of ecchy- 
moses, first on the lower extremities and but 
tocks, and, a few days later, *m the arms. In 
Appearance these blotches were first a mottled 
scarlet ; and after twenty-four hours they 
would become darker, then dark purple, and 
later green, and finally yellow — thus under- 
going the same changes in color as ecchymoses 
from a bruise. These subcutaneous haemor- 
rhages became multiple. The effusions fre- 
quently coalescing ; but each blotch, or collec- 
tion of effusions, was usually separated from 
its neighboring blotch by a clear but short in- 
terval. The effusions were larger on the 
lower than on the upper extremities, and 
largest of all on the buttocks, where there 
were discolorations as large as the palm of a 
hand. As one set of blotches were disappear- 
ing, fresh ones would form, so that it was not 
uncommon to find effusions in all the various 
stages of change on the body at the same time. 
These haemorrhages, however, did not come 
and go periodically, or with any regularity ; 



196 SAISTGUIISTARIA. 

but when they did appear it was usually in 
the night, and would be first noticed the next 
morning. Effusions did not occur on the trunk 
above the waist, nor on the head, excepting a 
very few miliary effusions in the external ears. 
The effusions were, therefore, limited to the ex 
tremities, with the exception of the buttocks 
and ears ; and were generally larger posterior- 
ly than anteriorly. Accompanying these ec- 
chymoses there was intermittent fever, aro- 
rexia, partial insomnia, and anasarca confined 
to the extremities — more in the legs than in the 
arms. There was no fever in the forenoon ; 
and then the child was somewhat playf ul ; and 
could use his legs freely, and made no com- 
plaints. But every afternoon about 2 P. M.. 
a slight fever would come on and disappear 
again before the next morning. During the 
fever the child was cross and fretful and de- 
sired his mother to hold him. He also com- 
plained of his legs hurting him, and would not 
stand on them, nor walk, unless made to do so. 
When forced to w r alk he did so with difficulty 
and complaining ; and his walk was stiff and 
clumsy. The anasarca was worse in the after- 
noon, as were all his symptoms, inconsequence 
of the fever. There were no internal haemor- 
rhages ; and the gums were not soft and spongy, 
as in scurvy. His bowels were regular ; and he 



PATHOGEXESY. 197 

had no headache, chill, or sweat. None of the 
purpuric blotches were elevated above the sur- 
face of the skin, and none suppurated. After- 
noons, when the disease was at its worst, his 
flesh was sensitive to pressure. 

The old-school physician, on the appearance 
of rhe purpura, administered calomel ; but 
when I first saw the child, a few days later 
(and by the way, I only saw him once, and 
then was in the house with him for twenty- 
four hours), I substituted lachesis, sixth cen- 
tesimal trituration, a powder every two hours. 
The next morning a fresh lot of effusions were 
visible ; and his general condition was no bet- 
ter. I then decided that arsenicum was a more 
appropriate remedy, as h covered the anasarca, 
the fever, and general condition ; and pre- 
scribed the sixth centesimal trituration, at first 
every hour for a short time, and then every two 
hours. The following day the child was very 
much better. The anasarca of the legs had di- 
minished considerably, the afternoon fever did 
not come on until two hours later than usual, 
and then with less severity. Arsenicum was 
just the remedy ; the convalescence began with 
its administration. The anasarca quickly dis- 
appeared ; the afternoon fever was vanquished 
in two days, and in two days more the cure 
was completed. On the night of the second 



198 



S A 1ST G U I 1ST A R I A, 



day after beginning arsenicum, there appeared 
a slight crop of purpura ; but, with this excep- 
tion, nothing marred a very speedy recovery. 
The whole duration of the disease was not 
more than two weeks ; and had arsenicum been 
administered at the outset instead of calomel, 
and afterwards lachesis, I verily believe the 
disease would have yielded almost immedi- 
ately. 

It is interesting and instructive to notice the 
parallel between Dr. Decker's case and the 
well-known symptoms of purpura rheumatica 
(the jjeliosa rheumatica of Schonlein). 



Dr. Decker's Case. 

Subject young, aged three 
years, but had suffered from 
no previous attack of rheu- 
matism. 

Purpuric blotches varying 
in size from a ten-cent piece 
to the palm of a hand. 

The purpuric blotches oc- 
curred on the lower and up- 
per extremities, but not on 
the trunk above the waist. 

On first appearing the 
blotches were bright red 
(scarlet), and did not disap- 
pear under pressure ; that is 
they were true extravasa- 
tions from the first. 



Purpura Rheumatica . 

Usually attacks young 
subject with delicate skin, 
who have already suffered 
from rheumatism. 

The purpuric spots vary in 
size, but are mainly small 
and round — from pin-head 
size to that of a split pea. 

The purpuric spots occur 
mainly on the legs, and 
about the affected joints. 

The spots at first may be 
due to simple hyperemia, 
and in that case disappear 
under pressure ; but even so 
they quickly become hemor- 
rhagic, and darken in color. 



PATHOGEN 32 SY 



199 



Dr. Decker's Case. 

The extravasations oc- 
curred in the sub-cutaneous 
ceJlular tissue — rarely in the 
skin. 



No elevations, from ex- 
travasations, above the gen- 
eral surface of the skin. 



The ecchymoses appeared 
in successive crops, without 
regularity or periodicity. 



The purpuric blotches un- 
derwent the same changes 
in color as a bruise. 



Complained of pain in the 
legs only in the afternoon. 



Purpura Rheumatica. 

The extravasations are in- 
to the tissues of the skin, 
and except in very grave 
cases do not, to any consid- 
erable extent involve sub- 
cutaneous tissue. 

When the patches are 
large and discreet they are 
often perceptibly elevated ; 
apparently from local cede- 
mae of the cutaneous, and 
perhaps likewise of the sub- 
cutaneous tissues. 

The purpuric spots fre- 
quently alternate with at- 
tacks of rheumatoid pain in 
the joints, as one becomes 
more pronounced the other 
lessens, or disappears. This 
alternation may go on for 
weeks. 

The striking resemblance 
of the ecchymoses of traum- 
atism and of purpura, has 
been dwelt upon by number- 
less observers ; but the pur- 
puric spot is apt to ripen 
and fade at a quicker rate 
then an ordinary bruise. 

Pain in the legs, more par- 
ticularly in the neighbor- 



200 



SANGUINAEIA 



Dr. Decker's Case. 



Legs swollen and slightly 
cedematous — no pitting on 
pressure. 



Fever intermittent, 
came on about 2 P. M. 



and 



Purpura Eheumatica. 

hood of the joints, is often 
the preliminary of an attack 
of the rheumatic form of 
purpura. , 

Legs swollen and oedema- 
tous. 

Fever generally accom- 
panies the attack. 

The disease usually lasts 
several weeks, with repeated 
relapses. 



The disease did not last 
but about two weeks. It, 
however, gave every evi- 
dence of persistence, and if 
it had not been brought to 
an end by the administra- 
tion of the appropriate rem- 
edy, would probably dragged 
along for a considerable per- 
iod before the toxic influ- 
ence of the sanguinaria was 
completely exhausted. 



The question naturally arises, was the 
appearance of the ecchymoses, within twenty- 
four hours after an overdose of sanguinaria, a 
pathogenetic effect of that drug, or a mere 
coincidence ? Dr. Decker is of the opinion 
that sanguinaria induced the disease, and I 
think the inference is well taken. The follow- 
ing correspondences are worth noting. 



PATHOGEKESY 



201 



Dr. Decker's Case. 

Afternoon fever about 2 
P. M., daily. 



Rheumatoid pains in the 
legs which came on every 
afternoon and disappeared 
before the next morning — 
worse in the evening and at 
night. 



Sanguinaria Pathogenesy. 

Afternoon fever, with cir- 
cumscribed red cheeks. Fev- 
er 2 to 3 P. M., daily.— Her- 
ing. 

Febrile condition came on 
at 2:30 P. M., not as severe 
as the day previous, and 
passed off between 8 and 9 
P. M. (fourth day); the fever 
recurred four or five days, 
gradually subsiding, yet 
very regularly between 2 
and 3 P. M. [Dr. Tinker, 
Trans. Arner. Inst, of Horn., 
1870 ; proving, with tincture 
of dried root, 10 drops first 
and second days.] 

In the evening the leg and 
foot swelled, with terrible 
burning pain ; she did not 
know where to lay the limb; 
the pain lasted until mid- 
night : she had to nurse the 
limb continually ; after mid- 
night the pain became eas- 
ier, but continued until the 
next day [Compilation by 
Dr. A. K. Hills, North Arner. 
Jour, of Horn., N. S., 3, 359. 
Arranged by Dr. B. Fincke]. 

Most of the symptoms 
seem to be aggravated in 
the evening. [C. Herixg, 



202 



SANGUINARIA 



Dr. Decker's Case. 



On walking in the after- 
noon all the joints seemed 
to be stiff. Both legs swoll- 
en, and slight anasarca, 
most marked at night. Com- 
plaining of pain in the legs. 



Sanguinaria Pathogenesy. 

New Archiv. fur Horn., 2, 2 y 
114]. 

Rheumatic pain in left, 
also inside of right thigh. 
Bruise-like pain in thigh. 
Wandering pains worse at 
night [Ibid.] 

Stiffness and tension in the 
hollows and sides of the 
knees. [Dr. Huseman, prov- 
ing with sixth dilution]. 

Extremely weak in the 
knees and lower extremities 
in the evening. Bruised 
pain in the left hip-joint, 
when walking. Stiffness in 
the limbs. Pain in the left 
foot. Burning in the soles 
of the feet, worse at night. 
[Dr. Bute, effects of first di- 
lution]. 



Muscles apparently lame 
in the afternoon, and sensi- 
tive to moderate pressure. 



Severe rheumatic pain in 
lower extremities, so severe 
as to cause serious lameness 
in walking. [Dr. Tinker, 
loc. cit.\ 

Left leg aad foot swell, at 
4 P. M. [Dr. A. K. Hills, 
loc. cit.] 

Stiffness of the nape of the 
neck. Rheumatic pains in 
the nape of the neck, shoul- 



PATHOGENESY. 



203^ 



Dr. Decker's Case. 



Restless and wakeful. 



Loss of appetite. 



Numerous hemorrhagic 
effusions just under the skin, 
and in the cellular tissue, of 
various sizes, the most of 
them as large as a fifty cent 
piece, and some of them as 
large as the palm of the 
hand. They came in suc- 
cessive crops on the legs, 
buttocks and arms, and al- 
ways in the night. 



Sanguinaria Pathogenesy. 
ders and arms when touched. 
[Dr. Bute ; effects of first 
dilution.] 

Restless tossing all night, 
with troublesome dreams. 
[Dr. Tinker, loc. cit.] 

Passed, a very restless 
night till toward morning 
perspiration broke forth 
freely, when most of the se- 
vere pains abated. [Ibid.] 

Little sleep, many busy 
unpleasant dreams. [Dr. B. 
Fincke, loc. cit.] 

Almost a total loss of ap- 
petite. No desire for food. 
[Dr. Tinker, loc. cit.] 

Longing for indefinite 
things with loss of appetite. 
Loss of appetite with uncer- 
tain cravings. [Dr. Bute,. 
loc. cit.] 

Loss of appetite. [Case of 
poisoning ; Amer. Jour, of 
Med. Sciences, 1841, 2,506.] 

Although the pathogenesy 
of sanguinaria shows, as far 
as I am aware, no other 
case, beyond Dr. Decker's, 
of purpura, yet in the judg- 
ment of many excellent 
practitioners it has a positive 
action upon the blood and 
blood-vessels. The Eclectic 
physicians rely upon it in 
the treatment of hasmor- 



204 SANOUINARIA 



Sanguinaria Pathogenesis. 

rhages, particularly epistax- 
is, menorrhagia, and haem- 
optysis. E. M. Hale sug- 
gests it in sanguinous apo- 
plexia, and when the gums 
are spongy and bleeding ; 
while Burt asserts its cura- 
tive power in haemorrhoids. 
It certainly has a very im- 
portant and characteristic 
action upon the pulse-rate 
and tension as is shown in 
the experiments of Tully 
Downey, Bird, and others. 



Clinical. — The following case has been only 
quite recently under observation, and amply 
illustrates the power of sanguinaria in the cases 
for which it is adapted : 

Mrs. E. F. H., a widow, aged sixty-three, a 
former patient of my father's, but whom I had 
not seen for some years, applied for treatment 
on July 17th of this year, for a peculiar form 
of rheumatoid pain in the hands and forearm. 
She had been a rheumatic subject for a score 
or more of years, but the pains had formerly 
been in the shoulders and in the "neighborhood 
-of other large joints. She had, at this time, 
no pain above the elbow, the rheumatism hav- 
ing confined itself to the parts below that 



CLINICAL CASES. 205 

point, and to the feet, for about eight or nine 
months ; but the right shoulder was per- 
manently crippled by the former attacks, and 
so stiffened that she could not bring the hand 
on that side to her head, and all backward 
movement was greatly abridged. Digestion 
was, and had been for years, enfeebled ; still 
she could with care prevent any serious attack 
of dyspepsia. The bowels were, naturally 
enough, torpid ; but she had two or three fair- 
ly good stools each week, unless she permitted 
her stomach to be overloaded with food diffi- 
cult (for her) of digestion ; which indiscretion 
was usually followed by a sharp attack of 
diarrhoea. For some time the pains in the 
hands had been growing more and more severe, 
until at last, after having passed a restless and 
, distressed night, she applied for relief very 
early in the morning of the day already men. 
tioned. Seven of the joints of the right hand, 
and three on the left, were swollen,' hot and 
painful. She described the sensation, u As if 
they were on fire." The actual local temper- 
ature was not much increased, as far as I could 
judge by contact, and the bodily temperature 
was even slightly sub-normal, but the subject- 
ive sensation was one of violent heat in the 
painful parts. With this was a tired feeling, 
and a sense of weakness, which may have been 



"306 SMJGUINARIA. 

mainly due to the loss of sleep. There was a 
noticeable exacerbation of the pain about sun- 
down, which continued until midforenoon, 
when there would be considerable relief until 
again in the afternoon. A study of the 
stomach symptoms showed a rather indifferent 
appetite, chough a sufficiency of food was in- 
gested. An excess of fatty or richly nitroge- 
nous foods caused burning pains in the stomach, 
slight nausea, never going on to vomiting, re- 
gurgitations and eructations ; this being fol- 
lowed, as I have already said, by papescent or 
liquid stools. She was naturally of a very 
bright and sunny disposition, but it seemed to 
me, from the remarks she let fall about her 
surroundings, the people she lived with, and 
other matters, that she was in a rather querel- 
lous mood. The whole case reminded me so 
forcibly of sanguinaria, that I decided to give 
that remedy in the sixth decimal trituration. 
Sanguinaria has the following symptoms: 

Very irritable and morose, and impatient at 
the least trifle. 

Irritability ; she could break things to pieces 
without any cause. 

Appetite much impaired. 

Loss of appetite, with uncertain cravings. 

Aversion to butter. 

Violent, though transient, gastrodynia. 



CLINICAL CASES. 207 

Spasmodic eructations ; frequent eructations 
of a bad odor ; eructations of wind from the 
stomach. 

Regurgitation and disposition to vomit. 

Bitter vomiting ; it sometimes occasions 
vomiting, but more especially burning at the 
stomach. 

Slight nausea, with a burning at the stomach. 

Disagreeable sensation at the stomach ; sen- 
sation as of indigestion ; heavy, dull sensation, 
with qualmishness, eructations, and very dis- 
agreeable feelings in the stomach. 

Burning sensation in the stomach. 

Stools soft (first days) ; hard (latter days). 

Five natural evacuations in one day. 

Rheumatic pain in the right shoulder. 

Violent pain in the shoulder joint. 

Rheumatic pain in the right forearm. 

Redness of the hands with violent burning. 

Violent pain in the right hand close to the 
index linger. 

Ulcerative pain in the right thumb, after- 
wards in the left, then extending to all the 
fingers, one after another. 

Cutting pain in the joints of the finger. 

Burning pains in the feet, worse at night. 

Sensation of weariness and lassitude through- 
out the system. 

Great weakness ; very great prostration of 
strength. 



208 sanguinaeia. 

Most of the conditions aggravated in the 
evening or at night. 

As I was preparing the medicine we con- 
versed on various topics, in the midst of which 
she incidentally called my attention to a pecu- 
liar condition of her skin. About the wrist, 
and extending upward to the elbow, in the 
region of the clavicle, upon the thighs, and on 
the dorsum of the feet and balls of the toes, 
were little round, and roundish, purpuric 
spots, varying in diameter from the six- 
teenth to half an inch, but mostly quite 
small. They were painless, were unaffected 
by pressure, each lasted several days, gradual- 
ly fading like a bruise, and were most profuse 
on the right side of the body, and on the 
posterior portion of the limb. This had been 
going on for several years, now better, now 
worse, but never quite disappearing, and on 
the whole being more definitely pronounced, 
and larger in size, season by season. There 
was no history of haemorrhages. 

I remembered Dr. Decker's case, as it very 
much interested me at the time it was read, at 
the Ithaca meeting, and wondered whether 
sanguinaria would show any effect here, but as 
I did not know of the purpuric spots at the 
time of deciding upon the remedy, these had 
no influence in the selection on sanguinaria. I 



CLINICAL CASES. 209 

saw nothing further of this patient for five or 
six weeks, when she called to report that the 
medicine had helped her very much, and to 
say that she had had during the past month 
less rheumatism than for any like period for 
years. The purpuric spots had completely 
vanished, and have not up to this date (four 
months) returned. She has now only transient 
rheumatic pains, rarely severe enough to cause 
actual suffering, but the affected joints remained 
enlarged and stiff. She still takes a dose of 
sanguinaria whenever she has a paroxysm, and 
it seems to quickly lull the pain ; she has taken 
no other remedy whatever since the middle of 
July last. 

HYDROCYANIC ACID. 

Prussic acid disorganizes the blood, rendering 
it bluish-black and noncoagulable. From its 
fugaciousness it does not seem probable that 
its influence is permanent enough to produce 
purpura, and it is introduced here merely on 
account of its apparent usefulness in the 
subjoined case. 

Clinical. — Prof. Reuben Ludlam, M. D., 
published the following case of purpura haem- 
orrhagica at the climateric, in the Chicago 
Clinique, January 15, 1885. (Volume VI, 
page 31). A number of remedies had been 
used, but the patient finally recovered under 
hydrocyanic acid. 



210 HYDROCYANIC ACID. 

1. Mrs. B., aged forty-eight years, has .been 
married thirty-one years. She has had five 
children and three miscarriages, the last being 
a miscarriage at four months, which occurred 
about seven years ago. The menses appeared 
soon after her twelfth birthday, at which time 
she contracted a severe cold by washing her 
underclothing and putting it on again while it 
was still wet. Her menstrual history from that 
time is one of great irregularity, the menses 
usually being too frequent, too profuse and 
lasting for a long time. Sometimes, however, 
six weeks would pass without their appearance, 
but the flow was always profuse and long-last- 
ing. The menses were usually preceded by an 
intense headache, with a flushed face and 
intolerance of light or sound. Epistaxis was 
frequent, and it often occurred several times a 
day. 

Four years since she was treated for some 
displacement of the uterus, and wore pessaries 
of various sizes, shapes and material. These 
manipulations and instruments produced intense 
pain and inflammation, which finally resulted 
in a pelvic abscess. For the last two years her 
menses have been absent at times for three 
months ; then again there would be an interval 
of two to six weeks. They were always profuse, 
continuing from ten to fourteen days. In the 



CLINICAL CASES. 211 

latter part of October, 1884, she observed 
numerous dark purple spots on the lower 
extremities. Their appearance was preceded 
by aching and weariness of the limbs, with 
profuse menorrhagia and frequent haemorrhage 
from the nose. 

The night of November 4 she was attacked 
with vomiting and diarrhoea, the stools and 
ejecta consisting mostly of blood. The 
physician who was called prescribed the 
inevitable Ergot, gave a guarded prognosis, 
and was altogether so indifferent that they for 
the first time resolved to try homoeopathy, and 
November 8 I was called to attend her. I found 
her frightened, anxious, with a weak, almost 
imperceptible pulse, the lower extremities cold 
and oedematous, and covered with a purplish 
eruption to the hips, the spots varying in size 
from that of a pin head to a ten-cent piece, and 
they would not disappear from pressure. There 
was constant nausea and occasional vomiting. 
The conjunctiva was injected, but no haemor- 
rhage had appeared from the eyelids, the ears 
or the mouth. There was no fever present, and 
the general health seemed unaffected, with the 
exception of the extreme weakness and tendency 
to faint. 

These symptoms were relieved by appropriate 
remedies. The eruption still at times makes 



212 HYDROCYANIC ACID. 

its appearance, and is at first of a bluish-purple, 
changing successively to greenish, blue-brown 
and yellow. The haemorrhages have not been 
repeated since she came under my care, although 
the menses appeared after being delayed two 
weeks. Previous to the petechia making its 
fresh appearance there will be fugitive rheu- 
matic pains in the limbs, then in the back and 
chest or head. When the head was affected 
the pain was agonizing, compelling screams 
from the patient, and was accompanied with a 
cold perspiration upon face and hands, and a 
sensation of coldness in head. For this condi- 
tion wratrum alb. did good service. The next 
morning the petechial spots covered the scalp. 
When first called ipecac, was indicated and 
given ; but lachesis 6 and 30, phosphorus 3, 
ledum 3, arnica 3, and arsenicum have been 
the remedies prescribed as the symptoms called 
for them. 

Mental and physical rest was strictly enjoined. 
Tea, coffee, and stimulating food or drinks were 
rigidly prohibited, and all food and drink were 
taken cold, and as little of the latter as was prac- 
ticable. Lemonade was allowed in moderate 
quantities. She had always been accustomed to a 
stimulating diet, with an occasional glass of 
wine or beer, which was of course denied her. 

This case, which I am privileged to show you 



CLINICAL CASES, 213 

through the kindness of our friend, Dr. C. T. 
Canfield, is a rare and a very interesting one. 
Its whole clinical history, the epistaxis, the 
irregular and copious menstruation, the cerebral 
congestion in advance of the monthly cycle, 
and the appearance of the peculiar spots which 
you have seen upon the legs of this patient, are 
so many points for study. The derangement of 
the menses through chill from wearing wet 
clothing at their first appearance was a mis- 
chievous factor of the subsequent ill-health ; 
and the approach of the climateric undoubtedly 
has to do with the development of purpura at 
this time of life. 

The treatment that she has received from Dr. 
C. was skillful and appropriate. Under it her 
last two periods have been only six weeks apart, 
and the flow has continued but four days 
instead of ten. Her general condition and 
spirits are greatly improved. The case has 
been well managed and the only suggestion 
that I have to offer is to put her upon a medium 
attenuation of hydrocyanic acid, which I have 
found to be a very useful remedy in other 
forms of purpura hsemorrhagica. The patient 
was given hydrocyanic acid 6 and 30 in 
alternation, and recovered rapidly. 

LEDUM. 

Skin. — Bluish spots, like petechia, over the 



214 LEDUM. 

whole body. [Hahnemann ; Materia Medica 
Pur a. Vol. iii, page 20.] 

Concomitants.— -The limbs and whole body 
are painful, as if bruised and beaten. 

The eruption burns and stings like insect- 
bites. 

Sensation of coldness, all over. 

Comments.— Hahnemann, as early as 1796, in 
Huf eland's Journal, called attention to the 
value of ledum in cutaneous diseases ; and 
Teste, in his Materia Medica, affirms the value 
of ledum in insect-bites, which are a sort of 
traumatic petechise. Ledum will probably 
never achieve a considerable reputation in the 
cure of purpura ; but in the gouty diathesis, 
and in that form of purpura which has been 
denominated peliosis rheumatica, it may prove 
of real service. In the subjoined case the ap~ 
pearance and location of the purpuric spots are 
such as we might reasonably expect in the le- 
dum case, but the profuse nose-bleed is not a 
characteristic symptom of this remedy. 

Clinical.— The following is reported to me 
by Prof. J. R. Kippax, M. D., of Chicago: 

1. The purpuric spots were small, and ap- 
peared mostly on the lower extremities near 
the joints. The patient suffered from profuse 
and long lasting epistaxis. Cured promptly 
by ledum 6x. 



215 

BERBERIS VULGARIS. 

Skin. — Two small red spots on each side of 
the forehead. On the forepart of the left 
shoulder three small, mottled, dusky-red spots. 
On the forepart of the right shoulder, two 
dusky-red mottled spots nearly confluent, one 
about a quarter of an inch, the other about 
five-fourths of an inch long, somewhat painful 
upon grasping it, as after a bruise of the skin. 
A pale dusky-red mottled spot as large as a 
half-dollar near the external condyle of the left 
humerus, at times burning and itching as if 
congested, in the middle of an elevated nettle- 
rash-like welt. Small dusky-red, petechial- 
like, at times slightly itching or burning spots 
on the forearm, also at times on the back of 
the hand, chiefly near the wrist and a few 
inches from it. [Hesse ; Journal fur Horn. 
Arzneien, 1, 1834 ; effects on Ave persons, of 
an infusion of the root.] 

Concomitants. — Bruised pain, with stiffness, 
lameness, and numbness in the lumbar and 
sacral regions ; worse while sitting or lying. 

Dryness of the mucous membranes. 

Comments. — Berberis cause engorgement of 
the venous capillaries, and may in this way 
sometimes be responsible for interstitial effu- 
sions ; but it is doubtful whether it ever proves 



216 LYCOPODITTM. 

of much service in the cure of purpura, except 
perhaps iu those rare cases in which this is 
consecutive to kidney disease. 

FEERUM PHOSPHORICUM. 

The phosphate of iron is such a capable rem- 
edy, in debilitated states of the system, that it 
ought to make a place for itself in the treat- 
ment of purpura. This it will probably do, 
but as yet its influence in this disorder remains 
undefined. 

Clinical. — The following case was reported 
to me by Prof. J. R. Kippax, M. D., of Chicago : 

1. This little child suffered for several days 
from loss of appetite, with great lassitude and 
general uneasiness. Suddenly petechial spots 
appeared in great numbers on the limbs and 
extended to the trunk and arms. Subsequently 
there was passive haemorrhages from the 
mouth and bowels, large quantities of black 
blood being passed. Hamamelis 3 x afforded 
some relief. The case was afterwards cured 
under ferrum phos. 6 x. 

LYCOPODIUM. 

Sluggishness of the peripheral circulation, 
and various forms of skin disorder, are charac- 
teristic of lycopodium ; but " spots like flea- 
bites," on the lower extremities, and u large 



CLINICAL CASES. 217 

red spots on the legs, which neither pain nor 
itch," are the only evidence in its pathogenesy 
of itspetechi^e-producing power. 

Clinical. — The following case, by Dr. Jno. 
C. Morgan, is from Hoyne's Clinical Thera- 
peutics, vol. i, page 275. 

1. C, aged ten, has been troubled for four 
months with cracked skin, especially on the 
feet, with purpura over the whole cutaneous 
surface ; unaffected by bathing. Family scrof- 
ulous. One dose of lycopodium 200 cured. 

In addition to the above the following reme- 
dies have been suggested by various authori- 
ties : 

Apis, Belladonna, Bovista, Cocci onella, 
Hyosciamus, Kali chloricum, Magnesium 
mur., Magnesium sulph., Nitric Acid, Nux 
Vomica, Phosphoric Acid, Ruta,, Silicea, 
Stramonium and Sulphur. 



REPERTORY. 

SKIN. 

Anaesthesia, profound cutaneous : Chloral 
Black, mottled, like a snake : Crotalus. 

Blisters, blood : Arsenicum, Lachesis, Lycopodium, Phosphorus, 
Secede. 

black : Lachesis 

blue : Lachesis. 

brown : Lycopodium, Phosphorus. 

— gangrenous : Secale. 

Blood oozing from skin : Crotalus, Lachesis. 

— boils : Arnica, Lachesis, Ledum, Lycopodium, Phosphorus, 

Secale. 

Bloodvessels, small, look like the foliage on the branches of 
a tree : Crotalus. 

much dilated : Chloral. 

Blotches (ecchymoses) of varying size, from ten-cent piece to 
palm : Sanguinaria. 

Braises very easily : Lachesis, Phosphorus. 

Bullae, with, containing purple fluid : Kall-hydriodivum. 

Burning sensation in the skin : Arsenicum, Lachesis, Lycopo- 
dium, Phosphorus, Rhus. 

at night : Arsenicum. 

in spots where ecchymoses are about to occur : Lachesis* 

Clammy skin : Lachesis, Secale. 

Coldness of the surface of the body, with : Crotalus, Lachesis, 
Secale. 

— and moist : Lachesis. 

— — dry : Crotalus. 

Creeping under skin, sensation of something : Secale. 
Dry and cold skin : Crotalus. 
Hyperaesthesia in the patches : Phosphorus. 



220 REPERTORY. 

Insensibility of skin : Crotalus. 

Itching : Berberis, Bryonia, China, Chloral, Lachesis, Ledum, 

Lycopodium, Mercurius, Phosphorus, Rhus, Sulphuric- 

acid. 

— intolerable : Mercurius, Rhus. 

— over whole body : Rhus. 

— spots in, where ecchymoses are about to occur : Lachesis. 
Jaundice, with : China, 

Patches, livid : Phosphorus. 
Leaden appearance of skin : Crotalus. 
Mottled all over like a leopard : Kali-hydriodicum. 
CEdema with redness and heat : Arnica. 

Oozing of blood from the pores of the skin : Crotalus, Lachesis. 
Paleness, remarkable, of skin : Phosphorus. 
Pallid skin : Crotalus. 
Parchment-like skin : Crotalus. 

Pressure causes black and blue mark, which spreads indefin- 
itely : Lachesis. 

— slight, leaves marks of fingers : Phosphorus. 
Prickling in the skin : Berberis, Hamamelis, Lycopodium. 

— subcutaneous : Hamamelis. 

in the veins : Hamamelis, 
Rash follows the course of the large nerve trunks : Chloral 
Specks like pin-heads, red, on hands : Phosphorus. 
Splotches, irregular : Lachesis. 

Spots, purpuric : Arsenicum, Berberis, Bryonia, Crotalus, Lach- 
esis, Ledum, Lycopodium, Phosphorus, Sangulnaria, 
Terebinthina. 
~ black : Arsenicum, Crotalus, Lachesis, Rhus. 

- blue : Arsenicum, Bryonia, Crotalus, Lachesis, Ledum, San- 

guinaria, Sulphuric-acid. 
~ — on abdomen : Arsenicum. 

- bluish-black : Lachesis. 

red '.'Lachesis, Phosphorus. 

— burning : Arsenicum, Berberis, Lachesis, Ledum, Mercurius, 

Rhus, bulphuric-acid. 

— circular : Lachesis. 



REPERTORY. 221 

Spots circumscribed, sharply : Arsenicum. 

— dark colored : Crotalus, Phosphorus. 
purple : Crotalus. 

red : Terebinthina. 

— dusky-red : Berber is, Terebinthina. 

— extend indefinitely, inclined to : Pltosphorus. 

— flea-bites, like : Arsenicum, Lycopodium, Secale. 

— gangrenous, inclined to become : Lachesis, Secale. 

— insect bites, burning and sting like : Ledum. 

— intense red : Terebinth but. 

— itching: Berberis, Iodum, Lachesis, Ledum, Lycopodium, 

Mercurius, Sulphuric-acid. 

— irregular-shaped : Luchesis 

— large : Crotalus, Lachesis, Lycopodium, Phosphorus. 

— as the hand : Ladies is. 

— livid : Crotalus, Tj(ichesis 3 Phosphorus. 

— marbled : Berberis. 
— painless : Ledum. 

— pin-head like : Pliosphorus. 
on the hands : Phosphorus. 

— purple : Arsenicum, Leichesis. 

on chest : Arsenicum. 

neck : Arsenicum. 

— red : Arsenicum, Berberis, Bryonia, Crotalus, lodum, Lachesis, 

Lycopodium, Mercurius, Phosphoi us, Sulphuric-acid. 
neither pain nor itch : Lycopodium. 

— round : Bryonia, Mercurius. 

— scarlet : Arsenicum, Bryonia, Lachesis, Mercurius, Phospho- 

rus. Terebinthina. 

— small : Bryonia, Lachesis, Lycopodium, Mercurius, Sulphuric- 

acid. 
near joints : Ledum. 

— stinging : Ledum, Lachesis, Mercurius. 

— violet : Phosphorus. 

— yellow : Crotalus. 

— and Stripes, : Phosphorus. 
Spotted like a snake : Crotalus. 



222 REPERTORY. 

Stinging sensation in the skin : Bryonia, Hamamelis, Rhus. 

— subcutaneous : Hamamelis, 

in the veins : Hamamelis. 

Stripes (vibices) : Phosphorus. 

Sweat, bloody : Crotaius, Lachesis; Lycopodium. 

— cold : Arsenicum, China, Mercurius, Secale, Sulphuric-acid. 

— covered, when : China. 

— debilitating : China, Mercurius. 

— greasy : Bryonia, China, Mercurius. 

— nightly : China, Mercurius, Phosphoric-acid. 

— partial : China, Phosphorus. 
side on which he lies : China. 

— profuse : China. 

— sleep, during : China. 

— wine, like putrescent : Lachesis. 
Tenderness of the skin : Chloral. 
Varicose veins, with : Hamamelis. 
Yellowness of skin : Phosphorus. 

BLOOD. 

Acrid : Blius, Sulphuric-acid. 

Black : China, Lachesis. 

Bluish-black : Hydrocyanic-acid. 

Bright : Arnica, Ledum, Mercurius, PhospJiorus, Rhus. 

Brown : Bryonia, Rhus. 

Coagulated : Arnica, China, Mercurius, Phosphorus, Rhus, 
Secale, Terebinthina. 

Dark : Crotaius, Hamamelis, Nux vomica, Phosphorus, Terebin- 
thina. 

Dark-red : Lachesis. 

Fluid : Crotaius. 

Non-coagulable : Crotaius, Hydrocyanic-acid, Lachesis, Phos- 
pJiorus. 

Offensive : Bryonia. 

Thin : lodum. 

Watery : lodum, Lycopodium. 



REPERTORY. 223 

Diseased vein-walls : Hamamelis. 
Inflammation of veins : Hamamelis. 
Peripheral circulation sluggish : Lycopodium. 
Venous capillaries engorged : Berberis. 

— stasis : Hamamelis. 

Extravasation of blood from all the tissues : Phosphorus. 

Haemorrhages : Arnica, Arsenicum, China, Crotalus, Ftrrum- 
phosphoricum, Hamamelis, Iodum, Lachesis, Phosphorus, 
Ledum, Lycopodium, Mercurius, Rhus, Secale, Sulphuric- 
acid, Terebinth ina. 

— black : China, Mercurius, Nux vomica, Sulphuric-acid. 

— bright : Arnica, Ledum, Phosphorus, 

— brown : 'Bryonia, Bhus. 

— dark red : Lacliesis, Nux vomica. 

— offensive : Bryonia. 

— thick : Arnica. 

— pale : Lycopodium. 

— passive : Hamamelis, Ferrum-phosphoricum. 

— every orifice, from, of the body : Crotalus, Sulphuric-acid. 
more pronounced than the skin symptoms : Phospltorus. 

— multiple ; nose, lungs, etc. : Arnica. 

— vicarious : Pliospltorus. 

— bowels, from : China, Secale. 

— kidnej 7 s : Secale, Terebinthina, 

— lungs : Arnica, Hamamelis. 

— mouth : China, Tereb'tntldna. 

— nose : Arnica, China. 

— uterus : Hamamelis, Secale, Terebinthina. 

bright and fresh blood : Hamamelis. 

midway between the menses : Hamamelis. 

Secretions, all, bloody : Phosphorus. 

Wounds, slight, bleed easily : Phosi)horiis. 

— pin-scratch bleeds for hours : Phosphorus. 

— slight pinching of skin causes bleeding : Lachesis. 

— scratching the skin causes bleeding '.^Lachesis. 



224 REPERTOBY. 

GENERAL CONDITIONS. 
Asthenia : Mercury. 
Benumbed, all the senses : Secede. 
Bruised, as if : Arnica, China, Crotalus, Hamamelis, Ledum. 

— body sore all over ; Arnica, China, Crotalus, Hamamelis, Le- 

eluin. 

— keeps changing from place to place, he feels so tired, sore 

and bruised : Arnica. 
Burning pains everywhere : Arsenicum, Phosphorus, Bhus. 

— increased by friction : Berberis. 

■ — interior parts : Bryonia, Mercurius, Phosphorus, Bhus, Se- 

cale. 
Coldness all over : Arsenicum, Cuprum, Ledum. 

— of affected parts : Mercurius; Bhus, Secale. 

Contact and motion aggravate his physical suffering : China. 
Debility: China, Crotalus, Ferrum-phof-phoiicum, Bh us, Secale. 

— following the loss of blood, or other fluids : China. 

— rapid sinking of strength : Secale. 

— soreness and stiffness, especially when at rest : Bhus. 

— with paralytic weakness : Bhus. 

Emaciation : Arsenicum, China, ierrum, lodum, Lycopodium, 
Secale. 

— of affected parts : Ledum. 

— with good appetite : lodum. 
Exertion, dislike for : China. 

— easily tired by slight : Crotalus, 

— indisposition and incapacity for : Chloral. 
Exhaustion : Lachesis, Sulphuric-acid. 

— with sense of tremor all over the body without trembling : 

Sulphuric-acid. 
Faintness : Crotalus. 
Gangrene : Lachesis, Secale. 

— of viscera : Lachesis. 

Glands, enlarged or atrophied : lodum, Kali hydriodicum. 

— pain in : Arnica, Lycopodium, Mercurius, Phosphorus. 
burning : Arsenicum, Phosphorus. 



REPERTORY. 225 

Heat, aversion to : Secale. 

— applied to any part of the body makes the patient worse : 

Secale. 

Heated, aggravation from getting : Bryonia. 

Intermitting or periodical symptoms : China. 

Jaundice : China, Lachesis, Mercurius, Rhus, Secale, Sulphuric- 
acid. 

Lassitude : China, Ferrum-phosphoricum, Lachesis, Sanguinaria. 

— with sensation of weariness : Sanguinaria. 
Malignancy, peculiar, of attack : Grotalus, Lachesis, Phosphor- 
us. 

Melanosis : Lachesis. 

Motion and contact aggravate sufferings : China. 

— fear of pain keeps niiri quiet : Bryonia. 

Mucous membranes, remarkable paleness of the : Phosphorus. 
Oedematous infiltration of tissues : Kali hydrhdicum. 

— tendencies : Arsenicum. 

Paleness, remarkable, of mucous membranes : Phosphorus. 
Paralytic weakness : Bhus. 

Periodical, or intermitting symptoms : Arsenicum, China. 
Prostiation : China, Chloral, Lachesis, Sanguinaria. 

— after slight exertion : Lachesis. 

— intense : Lachesis. 

— muscular strength utterly gone : Chloral. 

— profound : Sanguinaria. 

— with neither thirst nor hunger : China. 
Restlessness : Arnica, Arsenicum, Cuprum, Mercurius, Bhus. 

— constantly changes position : Arnica, Bhus. 
especially at night : Rhus. 

the bed on which he lies feels so hard it makes him 

tired : Arnica. 

— nervous trembling, with : Cuprum, 

— sleeplessness, with : Bhus. 

— and uneasiness : Bhus. 

Sensitiveness, excessive, of the nervous system : China. 

— to the (cool) air : Phosphorus, Bhus. 



226 EEPERTORY. 

Sighing, constant : Secale. 
Soreness : Arnica, Bryony t, Rhus. 

— with great debility : Rhus, 

— tired and bruised : Arnica. 
Stiffness and debility : Rhus. 

Stitching pains in various parts of the body, aggravated by 
least motion : Bryonia. 

Syncope : Lachesis. 

Tearing "pains, worse from movement, therefore keeps very 
still : Bryonia. 

Vaso-motor paralysis : Chloral, Sanguinaria. 

Weakness : Arsenicum* Cuprum, Phosphorus, Rhus, Sanguin- 
aria, Secale, Su 1 phuric-acid. 

— muscular : Chloral, Cuprum, lihus, Sanguinaria. 

— with sensation of tremor all over the body, without trem- 

bling : Sulphuric-acid. 

— with paralytic heaviness of the legs and feet : Rhus. 

MIJSTD AND DISPOSITION. 

Angry, inclined to be, and exceedingly irritable : Bryonia. 

— at trifles : Arsenicum. 

Alone, when, feels worse : Phosphorus. 
Anxiety and fear of death : Secale. 

— of conscience : Ferrum. 

— when alone : Phosphorus. ' 
Apathy : China. 
Arrogance : Lachesis. 

— thinks himself important : Cuprum, Ferrum, Lycopodium. 
Benumbed, all the special senses : Secale. 

Brain beats in waves against the skull : China. 

Confusion of thought, cannot keep the mind to one idea : 

Chloral. 
Death, fear of : Rhus, Secale. 

with great anxiety : Secale. 

fears he will be poisoned : Rhus. 

Defiant mood : Arnica, Lycopodium. 



REPERTORY. 227 

Delirium tremens, the mental phenomena of, when not caused 

by alcohol : Chloral. 
Discontented : Rhus. 
Dreams of great exertion, as rowing, swimming, etc. : Bhus. 

— about business or household affairs : Bryonia. 

— vivid or frightful : Bryonia. 

Efforts, mental, aggravate all the symptoms : China. 

Exhaustion, mental : Lachesis. 

Fatigue, mental : Ledum. 

Fear of death : Arsenicum, Lachesis. 

Forgetfulness : Lachesis. 

Fretfulness : Arsenicum, Bryonia, Phosphorus. 

Haughtiness : Lycopodinm. 

Headache : 

— intense : Cltina. 

— red face, with : Bhus. 

— rush of blood to head : Rhus. 

— throbbing : China, Bhus. 
after loss of blood : Clan a. 

Hurry, wants to do everything in a : Sulphuric-acid. 
Ideas, slow train of : China. 
Ill-humor : Bryonia, China, Phosphorus. 
Impatient at the least trine : Sanguinaria. 
Inability for mental labor : Lycopodium. 
Indifference : Arsenicum, China, Cuprum. 

— says he is well : Arnica. 

— apathetic : China, Phosphorus. 

Irritable : Cuprum, Iodum, Lycopodium, Mercurius, Phosphorus, 
Sulphuric-acid. 

— at the least trifle : Sanguinaria. 

— she could break things to pieces without any cause : San- 

guinaria. 
loquaciousness : Lachesis. 

— talks to himself : Rhus. 

Melancholy: Arsenicum, Crotalus, Lachesis, Lycopodium, Bhus. 
Mind clear, then unconscious, followed by inability to con- 
centrate the mind : Terebinthina. 



228 REPERTORY. 

Morose, very, and needlessly anxious : Bryonia, Ledum. 
Oversensitive to external impressions : light, odors, noises, 

contact : Phosphorus. 
Quick-witted : Phosphorus. 
Restlessness : Arsenicum, Cuprum. 

— as if some misfortune was impending : Cuprum. 
Sadness : Crotalus. 

— recurring regularly at twilight : Phosphorus. 
Sensitive disposition : Phosphorus. 
Sighing, constant : Bryonia^ Secale. 

Sleepiness : China, Ledum, Lycopodium, Phosphorus. 

— witri sleeplessness until midnight : Rhus. 
Speech slow and weak : Secede. 

Timidity : Bryonia, Lycopodium, Sulphuric-acid. 

— associated with a sense of extreme fatigue : Phosphorus. 
Tremulous weakness, as from impending evil : Crotalus. 
Uneasiness, constant, cannot lie still, must change position : 

Arsenicum. 
Vertigo, worse from turning or stooping, or when rising from 

lying : Iihus. 
Weakness, tremulous, as from impending evil : Crotalus. 
Weeps much : Cuprum. 

EYES. 
Black flickering before eyes : Lachesis. 
Blindness, transitory : Chloral, Mercurius, Phosphorus. 
Bloodshot : Chloral, Phosphorus, lihus. 

— and constantly watering : Chloral. 

— a slight knock near the eye involved the whole eye : Phos- 

phorus. 
Blua margin around : China, Secale. 
Blue wpots on conjunctiva : Arsenicum. 
Diplopia : Chloral, Joduni, Lycopodium, Rhus, Secale. 
Distorted : ' Cuprum, Lachesis, Secale. 
Escori.iting discharges : Arsenicum. 
Eyelids droop : Chloral, Mercurius. 

— cedematous : Phosphorus. 



REPERTORY. 229 

Fire, glare of, intolerable : Jlercurius. 

Glassy : Bryonia. 

Haggard : Aseracum, Cuprum, Secede. 

Haemorrhage from eyes : Crotalus, Phosphorus. 

Hemiopia : Lycopodium. 

Herpes on lids : Bryonia. 

Inflamed : Arsenicum, Bryonia, Ledum, Lycopodium, Rhus, 
Sulph uric-acid, Mercurius, Phosphorus. 

Lachrymation : Ferrum, Ledum, Lycopodium, Mercurius. Phos- 
phorus, Rhus, Sulphuric- acid. 

Motionless : Arnica. 

Pale, everything looks : Rhus. 

Petechiae on conjunctiva : Crotalus. 

Photophobia : Bryonia, Chloral, Mercurius, Phosphorus. 

Sight, dimness of : China, Chloral, Secale. 

everything looks black : Phosphorus. 

when moving the head : Secale. 

when rising up in bed everything turns black before the 

eyes : Secale. 

everything looks blue : Lachesis. 

Scabs on lids : Mercurius. 

Sunken : Arsenicum, Secale. 

Swollen : Rhus. 

— lids : Arsenicum. 

Tingling, crawling, around eyes : Arnica. 

Tremor of lids : Iodum. 

Veil, gray, before eyes : Phosphorus. 

Veins distended and red : Jlercurius. 

EARS. 

Bruising pain in ears : Arnica, Ruta. 
Dryness, sensation of : Phosphorus. 

Hardness of hearing : Arnica, China, Lodum, Ledum, Lycopo- 
dium, Mercurius, Phosphorus, Secale, Sulphuric-acid. 
Haemorrhage fr^m ears : Crotalus, Phosphorus. 
Humming in ears : China. 
Otalgia : Mercurius. 



230 REPERTORY. 

Rending, tearing, in ears : Mercurius, Phosphorus. 
Ringing in the ears : China. 

Roaring in the ears, with great difficulty of hearing : Secale. 
Stinging, stitches, in ears : Arnica, Mercurius, Phosphorus. 

NOSE. 
Bleeding : China, Crotalus, Erigeron, Hamamelis, Lachesis, Phos- 
phorus, Rhus, Secale, Terebinthina. 

— affords great relief : Hamamelis. 

— black : Lachesis, Secale. 

— blows much blood from nose : Phosphorus. 

— bright : Ledum. 

— clotted : China, Ferrum, Secale. 

— coagulated, worse at night : Rhus. 

— constant : Secale. 

— exertion, slight, causes : Phosphorus. 

— nose continually full of coagulated blood : Ferrum. 

— straining at stool causes : Phosphorus. 

— thin but soon coagulates : China. 

— trickling of blood from nose : Lachesis. 

— pale : Arnica, Ledum, Phosphorus, Rhus, Secale. 

— violet : Terebinthina. 

— with pale face and ringing in ears : China. 

Coryza with pain in the frontal sinuses : Kali-hydriodicum. 

Smell, sense of, benumbed : Secale. 

Tightness, feeling of, across the bridge of the nose : Hamamelis. 

FACE. 
Anxious : Cuprum. 

Benumbed sensation over whole forehead : Hamamelis. 
Blackish : China. 

— lips : Arse)dcum, China. 

Bloated : Arsodcum, Bryonia, China, Phosphorus. 
Blue : Arsenicum. 

— circles around eyes : China, Phosphorus, Secale. 

— lips : Cuprum. 
Brown : lodum. 

Burning sensation : Arsenicum, Kali-hydriodicum. 



REPERTORY. 231 

Cracked lips : Arnica, Arsenicum, Bryonia, Mercurius. 
Crowding pressure in the forehead between the eyes: Hamamelis- 
Dark red : Secale. 

— with burning : Bhus. 
Discolored : Crotalus, Secale. 
Disfigured . Arsenicum, lodum. 
Distorted : Cuprum. 

Dry lips : Bryonia, China. 

— and black : Phosphorus. 

Earthy : Arsenicum, China, Ferrum, Lycopodium, Mercurius. 

Fiery red : Rhus. 

Haggard : Chloral. 

Heat, sensation of : Arnica, Bryonia, Ferrum, Bhus. 

Hippocratic : Arsenicum, China, Phosphorus, Secale. 

Hollow : China. 

Leaden : Arsenicum, Lachesis, Mercurius. 

Livid : China. 

Lumps, indurations : Ledum. 

Pale : Arnica, China, Cuprum, lodum, Lycopodium, Mercurius, 

Phosphorus, Secede. 
Red cheeks, circumscribed : Sanguinaria. 
Redness, intensely suffused with a deep : Chloral. 
Sunken : Arnica, Arsenicum, China, Forum, Phosphorus, Secale. 
White of egg, as if, had dried on it : Sulphuric-acid. 

MOUTH. 

Bleeding, excessive and prolonged : Phosphorus. 

from a tooth cavity : Phosphorus. 

Breath fetid : Chloral, Kali-hydriodicum. 

— offensive : Lachesis, Phosphorus. 
Blood blisters : Arsenicum. 

Dry : Berber is, Cuprum, China, Lachesis, Lycopodium, Bhus. 
Expectoration streaked with blood : Terebinthina. 
Gums, bleeding : Phosphorus, Sanguinaria. 
from slight causes : Phosphorus. 

— spongy : Chloral, Sanguinaria. 
and swollen : Kali-hydriodicum. 



232 REPERTORY. 

Gums ulcerated : Cuprum. 

Petechiae : Crotalus, Phosphorus. 

Raw, mucous membrane : Chloral. 

Saliva, bloody : Arsenicum, Phosphorus, Rhus. 

— profuse : Kali-hydriodicum. 

— gummy : Lachesis. 

Thirst : Arsenicum, China, Mercurius, Phosphorus, Secale. 

— burning : Arsenicum. 

— intense : Lachesis. 

Tongue blistered and ulcerated : Chloral. 

— burning like fire : Terebinthina. 

— red, smooth and glossy : Terebinthina. 

STOMACH. 

Acids, longing for : Phosphorus. 

Anorexia : China, Ferrum-phosphoricum, Lycopodium, Rhus, 
Sanyuinaria. 

— aversion to butter : Sanyuinaria. 

— longing for indefinite things, with : Sanyuinaria. 

— no desire for food : China, Sanyuinaria. 

— with uncertain cravings : Sanyuinaria. 
Bitter, food especially bread tastes : RJats. 

Burning pain : Arsenicum, Bryonia, Phosphorus, Sanyuinaria. 
Disagreeable sensation : Sanyuinaria. 
Eructations : Arnica, Bryonia, China, Sulphuric-acid. 

— bad odor, of : Sanyuinaria. • 

— frequent : Sanyuinaria. 

— spasmodic : Sanyuinaria. 

— sour, after milk : China. 
Gastrodynia : Bryonia, Phosphorus. 

— violent but transient : Sanyuinaria. 
Heartburn : lodum, Sulphuric-acid. 

— after milk : China. 

Haematemesis : China, Crotalus, Lachesis, Phosphorus. 
Hunger : lodum, Rhus, Secale. 

— ravenous : lodum. 

— without appetite : Rhus. 



REPERTORY. 233 

Indigestion : Mercurius. 

— sensation as of : Sanguinaria. 

Nausea : Arsenicum, Bryonia, Cuprum, lodum, Lachesis, Lyco- 
podium, Mercurius, Phosphorus, Rhus, Secede. 

— with burning at stomach : Sanguinaria. 

— regurgitation and disposition to vomit : Sanguinaria. 
Paralysis, partial, of deglutition : Chloral. 
Qualmishness : Sanguinaria. 

Regurgitation of food, and disposition to vomit : Sanguinaria. 

Spicy things, longing for : Phosphorus. 

Thirst : Arsenicum, Bryonia, China, lodum, Mercurius. 

— for cooling drinks, which relieve the gastro-intestinal 

symptoms : Cuprum. 

— cold milk, for : Rhus. 

— sour drinks, for : China. 

Vomiting : Arsenicum, Cuprum, Lycopodium, Phosphorus. 

— bitter : Arnica, Bryonia, Sanguinaria. 

— blood : Arnica, Phosphorus: 

ABDOMEN. 

Ascites : Arsenicum, China, Ledum, Mercurius. 

Atrophy of liver, acute : Phosphorus. 

Bleeding from anus : Crotalus, Mercurius, Phosphorus. 

— and other openings of the body : Crotalus. 

Blood, discharged from rectum during stool : Phosphorus. 
Bloody stools : China, Ritas. 

— painless : China. 
Burning pain in : Arsenicum. 

— in rectum : Arsenicum. 
Coldness, sensation of : Terebinthina. 
Colic : Cuprum, Ferrum, Secale. 

Constipation : Bryonia, Lachesis, Lycopodium, Phosphorus, 
Sanguinaria, Sulphuric-acid. ' ' 

— alternating with diarrhoea : lodum, 

— the foeces being slender, long, narrow, dry, tough, and hard 

like a dog's ; voided with great difficulty : Phosphorus. 
Cramps : Bryonia, Cuprum, Bhus. 



234 REPERTORY. 

Cramps, with convulsions : Cuprum. 

Cutting pain in : Arsenicum, Bryonia, Lycopodium, Mercurius, 
Sulphuric-acid. 

Diarrhoea : Arnica, Arsenicum, Bryonia, China, Cuprum, Mer- 
curius, Phosphorus, lihus. 

— gelatinous : Chloral. 
Flatulenca : China, Phosphorus. 

— obstructed : lodum, Lycopodium, Phosphorus. 
Glands inflamed : Mercurius. 

— painful : Mercurius, Terebinthbta. 
— swollen : lodum, Mercurius. 

mesenteric : Arsenicum. 

Griping, pinching, pain in : Lycopodium, Mercurius, Sulphuric- 
acid. 
Hardness of : Arsenicum. 
Haemorrhoids : Arsenicum, Lerrum, Phosphorus, Sanguinaria. 

— burn like fire, and bleed profusely : Phosphorus. 
Itching at anus : Lycopodium. 

Melaena : Crotalus. 

Mucus discharged from anus : Mercurius, Phosphorus. 

— serous : Kali-hydriodicum. 
Paralysis of intestinal canal : Phosphorus. 
Pressing pain in : China, Cuprum, Terebinthina. 
Prolapsus of rectum : Lachesis, Lycopodium, Mercurius. 
Rending, tearing, pain in : Phosphorus. 

Spleen enlarged : Arnica, Phosphorus. 

Stinging, stitches, in : Bryonia. 

Stools, frequent but natural : Sanguinaria. 

— soft : Sanguinaria. 
Swollen : Lodum. 
Tenesmus : Mercurius. 
Throbbing : Sanguinaria. 
Twitching in : Rhus, Sulphuric- acid. 
Varices al>out inguinal : Berberis. 

Weakness and emptiness, sensation of, in abdomen : Phos- 
phorus. 



REPERTORY. 235 

URINARY ORGANS. 

Albuminuria : Phosphorus. 

Blood discharged from urethra : Cantharis, Lycopodium, Secale. 

Bloody urine : Phosphorus, Terebinthina. 

— the blood is thoroughly mixed with the urine : Terebinthina. 
Blood-red urine, discharge of a few drops ol : Rhus. 
Dysuria : Arsenicum, Cantharis. 

— urine scanty : Erigeron. 
Glycosuria : Phosphorus. 

Scanty urine : China, Erigeron, Terebinthina 

— depositing brick-dust sediment : China. 

epithelial sediment : Terebinthina. 

Strangury : Cantharis. 

— with great loss of blood : Terebinthina. 
Turbid : Mercurius. 

— brick-dust sediment : China. 

— epithelial sediment : Terebinthina. 
Unconscious urination : Chloral. 

MALE GENITALS. 

Aversion to coition, or irrisistible desire : Phosphorus. 
Scrotum, blue spots on : Arsenicum, PJtosphorus. 

FEMALE GENITALS. 

Menses coagulated : Arnica, China, Ferrum, Rhus. 

— dark : China, Lachesis. 

— pale : Berberis, China. 

— — with dark coagula : China. 

— profuse : Lachesis. 

dark, coagulated : Lachesis. 

with pressing downward : Lachesis. 

— suppressed : Bryonia, Cuprum, Lycopodium. 
with violent, unbearable cramps : Cuprum. 

— watery, Berberis, China, Phosphorus. 

THROAT AND CHEST, 
Anxious respiration : Secale. 



236 REPERTORY. 

Bloody expectoration : Arnica, Bryonia, Ferrum, Ledum, Ly co- 
podium, Rhus, Phosphorus, SidpJturic-acid. 

— spitting, from throat : Crotalus. 
Cold air, longing for : Laches is. 
Dryness in throat, without thirst : Lachesis. 
Dyspnoea : Arsenicum, Iodum, Lachesis, Phosphorus. 

— cannot breathe with head low : China. 

— expiration easier than inspiration : Chloral. 

— as from inhaling acrid vapors : Cuprum. 

— shortness of breath : Lachesis. 

Haemorrhage : Arnica, China, Ferrum, Phosphorus, Rhus. 

— clearing throat causes : Phosphorus. 

— coughing causes : Phosphorus. 
during : Lachesis. 

Hoarseness : Iodum, Mer curias, Phosphorus, JRhus, Sulphuric- 
acid. 
Suffocative sensation on awaking : Lachesis. 
when lying, must sit up : Arsenicum. 

HEART AND CIRCULATION. 

Cardiac derangements caused : Phosphorus. 
Debility of the heart : Crotalus. 

Fever : Arnica, Arsenicum, Bryonia, China, Lycopodium, Mer- 
curius, Phosphorus* Bhus. 

— begins at 2 P. M., and lasts until morning : Sanguinarva-. 

— intense paroxysms : Lachesis. 

— intermitting : Arsenicum, China, L'hus, Sanguinaria. 

— long-lasting, and coming on at irregular intervals : China. 
Palpitations : Arsenicum, Bryonia, Iodum, Lycopodium, Mercur- 

ius, Phosphorus, Secale, Sulphuric-acbd. 

— even while sitting : Phosphorus. 
Pulse accelerated : Lachesis, Bhus. 

— faint : Bhus. 

— feeble '.'Crotalus. 

— imperceptible : Cuprum, Rhus. 
almost : Crotalus. 

— intermittent : China, Secale. 



REPERTORY. 237 

Pulse, irritable : Chloral. 

— languid : Crotalus. 

— rapid : Bryonia, lodum, Lachesis, Mercurius, Phosphorus. 

— sluggish : Crotalus. 

— small : Cuprum, Secale. 

— soft : Ferrum, Rhus. 

— thread-like : Crotalus. 

— trembling : Crotalus, Rhus. 

— weak : Chloral, Crotalus, Rhus. 

Tumbled over, a feeling as if the heart : Crotalus. 

EXTREMITIES AND BACK. 
Aching in extremities, constant, exhausting : Lachesis. 
Anasarca in arms : Sanguinaria. 

worse afternoons : Sanguinaria, 

Beaten, arms as if they had been : Ledum. 
Bruised, arms as if : Ledum: 
Burning pain in hands : Sanguinaria. 

— spot on thumb : Lachesis. 
Chilliness in the extremities : Cuprum. 

Crawling or prickling sensation of the surface of the fingers 

especially the tips : Rhus. 
Cutting pain in joints of fingers : Sanguinaria. 
Hands swollen : Crotalus. 

Paralysis of limbs, without loss of sensibility : Cuprum. 
Purpura begins on shoulders and forearm : Chloral. 

— begins arms and legs : Lachesis. 

Redness of hands, with violent burning : Sanguinaria. 

Rheumatoid pain in right forearm : Sanguinaria. 

Severe pain about the joints, worse in moist and cold weather: 

Chloral. 
Tearing and burning in the shoulder and arm : Rhus. 
Ulcerative pain in right thumb : Sanguinaria. 

— extending to other fingers, one after another : Sanguinaria. 
Violent pain in right hand, close to index finger : Sanguinaria. 

Lumbar and sacral region, bruised pain, with stiffness, lame- 



238 REPERTORY. 

ness, and numbness, worse while sitting or lying : 

Berber is. 
Paralysis of muscles of back, without loss of sensibility : 

Cuprum. 
Purpura most pronounced on buttocks : Sanguinaria. 
Purpuric spots larger posteriorly than anteriorly : Sanguinaria. 

— larger on the lower than upper extremities : Sanguinaria. 
Rheumatoid pain in shoulders and arms (when touched) : 

Sanguinaria. 
Stiffness of the nape of the neck ; Sanguinaria. 
Violent pain in shoulder-joint : Sanguinaria. 

Anasarca, lower extremities : Sanguinaria. 

— worse afternoons : Sanguinaria. 

Beaten, legs feel as though they had been : Ledum. 
Bruised, legs as if : Ledum. 

Bruise-like pain in thighs, worse at night : Sanguinaria. 
Burned, legs pain as if : Lachesis. 

Burning pains in the legs (every night till midnight) : San- 
guinaria. 

— in feet, worse at night : Sanguinaria. 
Clumsy in walking : Sanguinaria. 

Cramps in the legs and feet, with great restlessness : extensor 
muscles most prominently affected : Cuprum. 

Icy-ooldness of feet : Lachesis. 

Purpura on lower extremities especially : Crotalus, Iodum. 

Rheumatoid pains in the limbs, with numbness and tingling: 
Bhus, 

Stiffness in walking : Sanguinaria. 

Stifmess and tension in hollow and sides of the knee : San- 
guinaria. 

— and swelling of the joints : Bhus. 
Swollen feet : Crotalus. 

Veins of the abdomen and thighs, protuberent and arbores- 
cent : Phosphorus. 
Weak knees : Sanguinaria. 



REPERTOEY. 239 

SLEEP AND DREAMS. 

Drowsy but unable to sleep : Bryonia, Crotalus, Ferrurn, Lach- 
es is, Secale. 

— afraid to sleep, so much worse after : Lachesis. 
Insomnia : Asenicum, Bryonia, Iodum, Phosphorus, Lachesis, 

Ledum, Sanguinaria. 
Restless sleep : Arsenicum, Lachesis, Phosphorus, Rhus, San- 
guinaria. 

— tossing all night, with troublesome dreams : Sanguinaria. 

— many busy, unpleasant dreams : Rhus, Sanguinaria. 

— difficulty of falling asleep, followed by frightful dreams : 

Phosphorus. 
Somnolence, tendency to : Chloral. 
Starting, frequent, during sleep : Arsenicum. 
Worse after sleep : Crotalus, Lachesis. 

STAGES AXD STATES. 

Afternoon aggravations : Cantharis, Iodum, Lycopodium, San- 
guinaria. 

— every other : Lycopodium. 

Alone, aggravation when : Arsenicum, Lachesis, Lycopodium. 
Arthritic pains, with : Bryonia, Ledum, Lycopodium, Mercurius- 

Rhus. 
Awaking on, worse : Arsenicum, Lachesis. 

— better : Phosphorus. 

Caused by alcoholism, chronic : Crotalus, Lachesis. 

— debility from fevers : Arsenicum, Cldna, Lachesis. 

— lack of nourishment : Arsenicum. 

— living in damp places : Terebinthina. 

— vaso-motor paralysis : Chloral. 
Constant change of symptoms : Sanguinaria. 

Crops, the purpuric spots come in : Crotalus, Lachesis, San- 
guinaria. 

Evening aggravation : Arnica, Lachesis, Lycopodium, Secale. 

Exertion of body aggravates : Arnica, Arsenicum, Bryonia, 
Lycopodium, Rhus. 



240 REPEETOEY. 

Forenoon aggravation : Sulphuric-acid. 

Midnight aggravation, about : Arsenicum, Ferrum, Rhus. 

Morning aggravation : Phosphorus. 

Relieved, pains, by perspiration : Sancjuinaria. 

by warmth : Arseyilcum. 

Worse from changes in the weather : Phosphorus. 

— emotional excitement : Phosphorus. 

— heat applied to any part of the body : Secale. 

— at night : Arsenicum, Rhus, Sanguinaria. 

— stimulants, from : Chloral. 
Winter, aggravation during : Rhus. 

Anaemic persons : Arsenicum. 

Animal fluids, loss of, caused : China, Ferrum, lodum, Lycopo- 

dium. 
Broken-down constitutions : China, Crotalus. 
Children who have grown rapidly : Phosphorus. 
Chlorotic girls : Ferrum, Lycopodium. 
Elderly persons, particularly women : China, Phosphorus, 

Sulphuric-acid. 
Dropsy, with : Arsenicum, China, Lycopodium. 

— after purpura : Helleborus. 

Emaciation, with : Arsenicum, China, Ferrum, lodum, Lycopo- 
dium. 

Fair complexioned persons : Phosphorus. 

Gouty diathesis : Ledum. 

Hysterical women : Bryonia, Phosphorus. 

Plethoric persons : Ferrum, Lycopodium. 

Rheumatic persons : Arnica, Bryonia, China, Ledum t Mercu. 
rius, Rhus. 

— disposition : Phosphorus. 

Scrofulous and syphilitic persons : Kali-hydriodicum. 
Stout persons,: Crotalus. 
Swarthy persons '.China. 
Tuberlosis : Arsenicum. 
Varicose diathesis : Hamarr.elis. 



